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Correspondence and Brief Communications
November 1, 2005

Effect of Obesity on Mortality in Severely Injured Blunt Trauma Patients Remains Unclear—Reply

Arch Surg. 2005;140(11):1131. doi:10.1001/archsurg.140.11.1131

In reply

We would like to thank Drs Zein, Albrecht, Tawk, and Kinasewitz for their commentary regarding our recent manuscript. We agree that many questions regarding the impact of obesity on the outcomes of trauma patients remain unanswered. While most studies find an increase in complications for severely injured obese individuals, there have been some conflicting results regarding any difference in mortality for obese trauma patients. Some earlier studies found no difference in mortality,1,2 while many recent publications have found obesity to increase mortality after traumatic injury.3-6 In addition, our group recently found a 60% increase in mortality for severely injured obese patients when evaluating a population of more than 1000 severely injured patients, including almost 300 obese individuals. Several possibilities exist as to why there is a discrepancy in findings among various studies. First, because of difficulty in accurately documenting patient weight upon admission, many investigations looking at obesity in trauma are flawed with small numbers of patients, which may not allow adequate analysis of mortality difference in an obese cohort. Additionally, it appears that the mortality difference between obese and lean patients with blunt trauma seems to widen with increasing severity of injury.6 Therefore, studies that evaluate a less critically injured population may not detect increased mortality in patients who are obese.