Patient selection: blunt trauma, apparently in adults
body mass index in kg per square meter =
= (body weight in kilograms) / ((body height in meters)^2)
Independent risk factors for mortality:
(1) severe head injury (approximate mean odds ratio 35)
(2) pulmonary contusion (approximate mean odds ratio 10)
(3) obesity (defined as BMI >= 30 kg per square meter) (approximate mean odds ratio 6)
(4) injury severity score > 20 (approximate mean odds ratio 5)
(5) age > 55 years (approximate mean odds ratio 1.6)
where:
• 37% of patients were from automobile accidents. Pulmonary contusions would indicate significant blunt trauma to the thorax.
• It would be interesting to see if there are higher risk subgroups associated with age, such as > 70 years of age.
• The odds ratio of mortality for moderate head injury might be helpful in using the data.
• The mortality rate for entire population was 20%.
• Multiple organ failure is at least 2 times more common in an obese patient vs a nonobese one.
One possible way to use this information is the following untested table:
|
Possible Combinations
|
Mortality Risk
|
|
severe head injury and any other risk factor
|
very high
|
|
pulmonary contusion and 3 of items #3 to #5
|
very high
|
|
severe head injury
|
high
|
|
pulmonary contusion and 2 of items #3 to #5
|
high
|
|
all 3 items #3 to #5
|
high
|
|
pulmonary contusion and 1 item from #3 to #5
|
moderate to high
|
|
2 items from #3 to #5
|
moderate
|
|
pulmonary contusion alone
|
moderate
|
|
1 item from #3 to #5
|
low to moderate
|
