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Citation
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Mishra R, Galwankar S, Konar S, Shrivastava A, Raj S, Choksey P, Mishra B, Agrawal A. Clin. Neurol. Neurosurg. 2022; 217: e107260. |
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Abstract
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INTRODUCTION: Obesity adversely affects the outcome in trauma patients. However, the impact of obesity on the severity of traumatic brain injury (TBI) and outcomes is not well known. This study aimed to explore the impact of obesity/body mass index on the severity and outcomes following TBI.
METHODS: A systematic review of the literature was conducted using PRISMA guidelines to answer three questions: Q1: Is obesity/increased BMI associated with less risk of head injury? Q2: Whether obesity is associated with less severity of head injury? Q3: What is the impact of obesity/BMI on outcomes following head injury? A comprehensive search using keywords and MeSH terms was conducted in PUBMED, Cochrane database, Google Scholar, SCOPUS, WEB of Science Core Collection, and ScIELO index (Last day of search 06.06.2021). We used the Newcastle-Ottawa assessment scale (NOS) to evaluate the quality of studies and the Cochrane ROBANS tool to evaluate the risk of bias. Data extraction was done using piloted forms, and meta-analysis was done using the Mantel-Haenszel method.
RESULTS: A total of 1088 citations were obtained with the search strategy. Eighteen studies matched inclusion and exclusion criteria and were included in the systematic review. The median quality of studies was 7/9 in NOS. There were fewer occurrences of head injury in obese individuals with an odd's ratio of 0.80% and 95% CI (0.69-0.93) with p = 0.004. More patients with BMI ≥ 30 had GCS ≤ 8 than patients with BMI < 30 with OR 1.08 (95%CI: 1.02-1.14). Obese patients had a more severe head injury (as per AIS) (58.9% vs 44.2%) and OR 1.83 (95%CI: 1.72-1.94), I(2) = 87% and p < 0.00001. Length of ICU stay was more in obese individuals with a standard mean difference of 0.29 (95% CI: 0.03-0.55), I(2) = 87%, p = 0.03. Similarly, obese individuals had a more extended hospital stay. There was no difference in mortality or ventilator days between obese and non-obese TBI patients.
CONCLUSIONS: Obesity was associated with lower incidence and higher severity of head injury. However, there was no conclusive evidence that obesity confers protection from sustaining a head injury. Though the length of hospital and ICU stay were longer in obese individuals, the impact of obesity on mortality was not significant. There was no conclusive evidence for association of obesity with long term functional outcome or mortality following TBI.
Language: en |