Are the rib fracture score and different computed tomography measures of obesity predictors for mortality in patients wi
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ORIGINAL ARTICLE
Are the rib fracture score and different computed tomography measures of obesity predictors for mortality in patients with rib fractures? A retrospective cohort study Thorsten Jentzsch1,2 · Valentin Neuhaus1 · Burkhardt Seifert3 · Rudolf M. Moos4 · Hans‑Peter Simmen1 · Christoph E. W. Schmitz1 · Clément M. L. Werner1 Received: 8 May 2020 / Accepted: 24 August 2020 © The Author(s) 2020
Abstract Background There is missing knowledge about the association of obesity and mortality in patients with rib fractures. Since the global measure of obesity (body mass index [BMI]) is often unknown in trauma patients, it would be convenient to use local computed tomography (CT)-based measures (e.g., umbilical outer abdominal fat) as a surrogate. The purpose of this study was to assess (1) whether local measures of obesity and rib fractures are associated with mortality and abdominal injuries and to evaluate (2) the correlation between local and global measures of obesity. Materials and methods A retrospective cohort study included all inpatients with rib fractures in 2013. The main exposure variable was the rib fracture score (RFS) (number of rib fractures, uni- or bilateral, age). Other exposure variables were CTbased measures of obesity and BMI. The primary outcome (endpoint) was in-hospital mortality. The secondary outcome consisted of abdominal injuries. Sex and comorbidities were adjusted for with logistic regression. Results Two hundred and fifty-nine patients (median age 55.0 [IQR 44.0–72.0] years) were analyzed. Mortality was 8.5%. RFS > 4 was associated with 490% increased mortality (ORadjusted = 5.9, 95% CI 1.9–16.6, p = 0.002). CT-based measures and BMI were not associated with mortality, rib fractures or injury of the liver. CT-based measures of obesity showed moderate correlations with BMI (e.g., umbilical outer abdominal fat: r = 0.59, p 4 was an independent risk factors for increased mortality. Local and global measures of obesity were not associated with mortality, rib fractures or liver injuries. If the BMI is not available in trauma patients, CT-based measures of obesity may be considered as a surrogate. Keywords Adiposity · Bone · Computed tomography · Diagnosis · Fat mass
Christoph E. W. Schmitz and Clément M. L. Werner have contributed equally. * Thorsten Jentzsch [email protected]
Clément M. L. Werner [email protected]
Valentin Neuhaus [email protected]
1
Burkhardt Seifert [email protected]
Department of Traumatology, University Hospital Zurich, University of Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
2
Rudolf M. Moos [email protected]
Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
3
Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
4
Medical Directorate, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Hans‑Peter Simmen [email protected] Christoph E. W. Schmi
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