Critical Illness

CI: Body Weight and Outcomes: Trauma Patients (2007)

Four primary research articles were evaluated for this topic. Subjects were primarily middle-aged to older adults (mean ages 45-65). Most studies consisted of primarily male subjects (41-80%). The patient population consisted of trauma patients.

• Monitoring and Evaluation
  In critically ill trauma patients what effect does weight have on mortality?

  • Conclusion

    There is fair evidence that mortality is increased in critically ill trauma patients with BMI > 30.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill trauma patients what effect does weight have on mortality?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Brown CVR, Neville AL, Rhee P, Salim A, Velmahos GC, and Demetriades D. The impact of obesity on the outcomes of 1,153 critically injured blunt trauma patients. J Trauma. 2005;59:1048-1051. 
      • Byrnes M, McDaniel M, Moore M, Helmer S and Smith R. The effect of obesity on outcomes among injured patients. J Trauma 2005; 58:232-237.
      • Choban PS, Weireter LJ, Maynes C, Obesity and Increased Mortality in Blunt Trauma. The Journal of Trauma, 1991:31(9); 1253-1257.
      • Neville AL, Brown CV, Weng J, Demetriades D, Velmahos GC. Obesity is an independent risk factor of mortality in severely injured blunt trauma patients. Arch Surg. 2004 Sep;139(9):983-7.
        
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006
     
  In critically ill trauma patients, what effect does weight have on infectious complications?

  • Conclusion
    There is limited evidence that BMI > 30 is not associated with increased rate of infection in critically ill trauma patients.
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill trauma patients, what effect does weight have on infectious complications?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Brown CVR, Neville AL, Rhee P, Salim A, Velmahos GC, and Demetriades D. The impact of obesity on the outcomes of 1,153 critically injured blunt trauma patients. J Trauma. 2005;59:1048-1051. 
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006
     
  In critically ill trauma patients, what effect does weight have on length of hospital stay?

  • Conclusion
    There is fair evidence that LOS is increased in critically ill trauma patients with BMI > 30.
  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill trauma patients, what effect does weight have on length of hospital stay?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Brown CVR, Neville AL, Rhee P, Salim A, Velmahos GC, and Demetriades D. The impact of obesity on the outcomes of 1,153 critically injured blunt trauma patients. J Trauma. 2005;59:1048-1051. 
      • Byrnes M, McDaniel M, Moore M, Helmer S and Smith R. The effect of obesity on outcomes among injured patients. J Trauma 2005; 58:232-237.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006
     
  In critically ill trauma patients, what effect does weight have on days on mechanical ventilation?

  • Conclusion
    There is limited and conflicting evidence that BMI > 30 impacts number of days on mechanical ventilation in critically ill trauma patients.
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill trauma patients, what effect does weight have on days on mechanical ventilation?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Brown CVR, Neville AL, Rhee P, Salim A, Velmahos GC, and Demetriades D. The impact of obesity on the outcomes of 1,153 critically injured blunt trauma patients. J Trauma. 2005;59:1048-1051. 
      • Byrnes M, McDaniel M, Moore M, Helmer S and Smith R. The effect of obesity on outcomes among injured patients. J Trauma 2005; 58:232-237.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006
     
  In critically ill trauma patients, what effect does weight have on cost of medical care?

  • Conclusion
    To date, adequately powered studies have not been conducted to demonstrate a significant difference in cost of medical care when comparing critically ill trauma patients with BMI > 30 to those with BMI < 30.
  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006