Interestingly underweight men were also more likely to die in a collision than their normal weight peers.
There were no significant differences among different types of vehicle, collision or use of seat belts, although almost a third of drivers who sustained a fatal injury were not properly belted.
The authors point to other research, showing that the lower body of obese drivers is propelled further forward on impact before the seatbelt engages the pelvis, because of the additional soft tissue which prevents the belt from fitting snugly, while the upper body is held back.
61 percent of U.S. adults are overweight or obese—and they present a growing problem in emergency departments across the country
Obesity—defined as a body mass index (BMI) greater than 30—is presenting problems for orthopaedic trauma surgeons across the country. Based on their size alone, obese patients require different treatment, whether in imaging the injury or positioning the patient on an operating room table, according to a series of papers presented during the Orthopaedic Trauma Association Specialty Day.
Stephen H. Sims, MD, moderator of the session, noted that obesity now rivals tobacco in terms of deaths, disability, and direct medical costs. More than 5 percent of total U.S. annual medical expenses are attributable to obesity; in 2003, the direct health costs of obesity were more than $75 billion.
According to a study presented earlier during the AAOS Annual Meeting, a 44-year-old woman with a BMI of 34 would have $11,000 more in hospital costs than if she had a BMI of 24. Among patients admitted for treatment following a frontal impact automobile crash, those with a BMI greater than 30 had a 39 percent re-admission rate.
Treating obese patients requires an unusual amount of effort, so much so that Dr. Sims urged the audience to submit claims for these patients with a modifier -22 and to document the difficulties in the operative note.
They also suggest that obese drivers may be more likely to have underlying health problems, which may contribute to their greater risk of death. But car design may need to change, they venture.
“The ability of passenger vehicles to protect overweight or obese occupants may have increasingly important public health implications, given the continuing obesity epidemic in the USA,” they write. And they add: “It may be the case that passenger vehicles are well designed to protect normal weight vehicle occupants but are deficient in protecting overweight or obese occupants.”
Obese patients with critical injuries from blunt trauma have worse outcomes than do leaner patients, according to a single-center review of more than 1,500 patients.
However, the new data failed to show an increased risk for death after blunt trauma in obese patients, Dr. Michael F. Rotondo said at the annual meeting of the Southern Surgical Association.
The findings are notable because the series they come from is the largest ever reported on the role of obesity in trauma outcomes, and includes the highest percentage of obese patients, said Dr. Rotondo, chairman of surgery at East Carolina University in Greenville, N.C.
The study included 1,543 patients treated for blunt trauma at East Carolina between July 2001 and November 2005.
All patients had an injury severity score of at least 16.
By Mitchel L. Zoler
Elsevier Global Medical News
BMJ-British Medical Journal