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Mulvihill H, Roster K, Lakhi N. Obesity as a Risk Factor for Adverse Outcomes After Pedestrian Trauma Accidents in the Pediatric Population. Pediatr Emerg Care 2024; 40:498-503. [PMID: 38718818 DOI: 10.1097/pec.0000000000003198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
OBJECTIVE The aim of the study is to determine whether overweight or obese children are at an increased risk for injury and adverse outcomes following pedestrian motor vehicle accidents. METHODS We performed a retrospective study of patients between the ages of 2 and 17 who were pedestrians injured in a collision with a motorized vehicle, presenting to a level 1 trauma center, between January 1, 2010, to December 31, 2021. Patients with admission weights falling above the 90th percentile of the Centers for Disease Control and Prevention's sex-specific growth charts were identified as overweight/obese, those below the cutoff were categorized as nonobese. Groups were compared regarding demographics, mechanism of injury, Injury Severity Score, and Abbreviated Injury Scale by body region of injury. Outcome measures included hospital admission, length of hospital stay, intensive care unit (ICU) admission, ICU length of stay, and mortality. RESULTS Of the 306 patients included, 72 (23.5%) were overweight/obese and 234 (76.5%) were nonobese. The mean Injury Severity Score scores were higher among overweight/obese patients (5.37 vs 8.74, P = 0.008). Overweight/obese children were more likely to sustain severe abdominal injuries (Abbreviated Injury Scale ≥ 3) (12.2% vs 5.1%; odds ratio [OR], 2.64; 95% CI, 1.07-6.56; P = 0.030), be admitted to the hospital (94.5% vs 74.3%; OR, 12.07; 95% CI, 2.87-50.72; P < 0.001), require ICU admission (31.0% vs 20.0%, OR, 1.87; 95% CI, 1.03-3.36; P = 0.036), and require a longer ICU stay (0.9 vs 0.4 days, P = 0.014) compared with nonobese patients. CONCLUSIONS Obese and overweight children are at increased risk for higher injury severity scores, severe abdominal injuries, and ICU admission after pedestrian motor vehicle accidents.
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Affiliation(s)
| | - Katie Roster
- From the New York Medical College School of Medicine, Valhalla, NY
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2
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Lin CH, Lu CW, Lin YC, Ma CY, Kang SC, Liao CH, Fu CY. Evaluation of the cushion effect in blunt abdominal trauma patients: A computerized analysis. Injury 2024:111677. [PMID: 38926016 DOI: 10.1016/j.injury.2024.111677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/17/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Obesity may serve as a protective factor in blunt abdominal trauma (BAT) patients due to a "cushion effect". In this study, we aim to use computed tomography (CT) scans to measure abdominal adiposity and its correlation with injury severity in BAT patients. METHODS We conducted a retrospective analysis of male BAT patients who had undergone CT scans. Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were manually measured and height-normalized for analysis at lumbar levels L2 and L3. Statistical methods were used to compare differences in adiposity between patients with and without severe abdominal injuries. For controls, we also compared adipose tissue in patients with and without severe trauma to the chest, where less fat typically accumulates. RESULTS We included 361 male participants and conducted a comparative analysis of their demographic and injury characteristics. Patients without severe abdominal injuries had significantly higher SAT and VAT indices at both L2 and L3 (p < 0.05). However, these measures showed no significant differences between patients with and without severe chest trauma. Solid organ injuries, particularly liver injuries, were associated with decreased SAT and VAT. CONCLUSION Increase abdominal adiposity was linked to lower abdominal injury severity and solid organ injuries, particularly liver injuries. In addition to conventional BMI for evaluating obesity, either subcutaneous or visceral adipose tissue over lumbar levels L2 and L3 can be used to assess the "cushion effect."
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Affiliation(s)
- Chia-Hui Lin
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chih-Wei Lu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Yu-Ching Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, 222 Maijin Road, Keelung, Taiwan.
| | - Cheng-Yu Ma
- Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan; Artificial Intelligence Research Center, Chang Gung University, Taoyuan, Taiwan; Division of Rheumatology, Allergy and Immunololgy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ching Kang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
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3
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Hsu TA, Fu CY. A natural armor of obese patients. Asian J Surg 2023; 46:4768-4769. [PMID: 37268468 DOI: 10.1016/j.asjsur.2023.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 06/04/2023] Open
Affiliation(s)
- Ting-An Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan, Taiwan.
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French SJ, Allison DB. Creativity in energy balance, obesity and feeding behavior research, some thoughts. Physiol Behav 2023; 266:114161. [PMID: 36958458 PMCID: PMC10164077 DOI: 10.1016/j.physbeh.2023.114161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/23/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
This review provides an overview of examples of especially creative work related to the fields of ingestive behavior, energetics (defined as the study of the acquisition, storage, and use of metabolizable energy by biological organisms and the causes and consequences of such acquisition, storage, and use), and nutrition, focusing on both individual works and discoveries, as well as bodies of works and in some cases the working styles of particular scientists. The paper then discusses some principles extracted from our observations as well as from the literature on creativity pointing out some factors that seem to make for more creative science and that can be done by individuals to promote creativity in their own work. Finally, we end with a short set of tips for the field in general to promote creativity among our ranks broadly.
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Affiliation(s)
- Stephen J French
- Adjunct Associate Professor, Department of Applied Health Science, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Suite 115, Bloomington, IN, 47405, United States of America
| | - David B Allison
- Dean, Distinguished Professor, Provost Professor, Indiana University School of Public Health-Bloomington, 1025 E 7th Street, PH 111, Bloomington, IN, 47405, United States of America.
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Hatt A, Lloyd R, Bolsterlee B, Bilston LE. Strain-dependent shear properties of human adipose tissue in vivo. J Mech Behav Biomed Mater 2023; 143:105924. [PMID: 37276651 DOI: 10.1016/j.jmbbm.2023.105924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/14/2023] [Accepted: 05/20/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Human adipose tissue (fat) deforms substantially under normal physiological loading and during impact. Thus, accurate data on strain-dependent stiffness of fat is essential for the creation of accurate biomechanical models. Previous studies on ex vivo samples reported human fat to be nonlinear and viscoelastic. When static compression is combined with magnetic resonance (MR) elastography (an imaging technique used to measure viscoelasticity in vivo), the large deformation properties of tissues can be determined. Here, we use magnetic resonance elastography to quantify fat shear modulus in vivo under increasing compressive strain and compare it to the underlying passive gluteal muscle. METHODS The right buttocks of ten female participants were incrementally compressed at four levels while MR elastography (50 Hz) and mDixon images were acquired. Maps of tissue shear modulus (G*) were reconstructed from the MR elastography phase images. Tissue strain was estimated from registration of deformed and undeformed mDixon images. Linear mixed models were fit to the natural logarithm of the compressive strain and shear modulus data for each tissue. RESULTS Shear modulus increased in an exponential relationship with compressive strain in fat: Gfat*=748.5*Cyy-1.18Pa, and to a lesser extent in muscle: Gmuscle*=956.4*Cyy-0.36Pa. The baseline (undeformed) stiffness of fat was significantly lower than that of muscle (mean G*fat = 752 Pa, mean G*muscle = 1000 Pa, paired samples t-test, t = -4.24, p = 0.001). However, fat exhibited a significantly higher degree of strain dependence (characterised by the exponent of the curve, t = -6.47, p = 0.0001). CONCLUSION Static compression of human adipose tissue results in an increase in apparent viscoelastic shear modulus (stiffness), in an exponentially increasing relationship. The relationships defined here can be used in the development of physiologically realistic computational models for impact, injury and biomechanical modelling.
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Affiliation(s)
- Alice Hatt
- Neuroscience Research Australia, PO Box 1165, Randwick, NSW, 2031, Australia
| | - Robert Lloyd
- Neuroscience Research Australia, PO Box 1165, Randwick, NSW, 2031, Australia; University of New South Wales, Faculty of Medicine & Health, 18 High St, Kensington, NSW, 2052, Australia
| | - Bart Bolsterlee
- Neuroscience Research Australia, PO Box 1165, Randwick, NSW, 2031, Australia; University of New South Wales, Graduate School of Biomedical Engineering, Library Rd, Kensington, NSW, 2033, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia, PO Box 1165, Randwick, NSW, 2031, Australia; University of New South Wales, Faculty of Medicine & Health, 18 High St, Kensington, NSW, 2052, Australia.
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Hsieh TM, Chuang PC, Liu CT, Wu BY, Liu YW, Hsieh CH. Protective Role of Obesity on Trauma Impact: A Retrospective Analysis of Patients with Surgical Blunt Bowel Mesenteric Injury Due to Road Traffic Accidents. Risk Manag Healthc Policy 2022; 15:1533-1543. [PMID: 36003412 PMCID: PMC9395217 DOI: 10.2147/rmhp.s374469] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background The "cushion effect" theory proposes that increased body mass index (BMI) is associated with less severe abdomen injury following blunt abdomen trauma, while the "obesity paradox" describes the protective effect of obesity against mortality. However, most previous studies used the abdominal abbreviated injury scale as the outcomes seemed to be inadequate owing to the injuries to the abdominal organs, such as the spleen and liver, which may be attributable to the force that caused the chest trauma. This study aimed to use adult trauma patients with surgical blunt bowel mesenteric injuries (BBMIs) to investigate the influence of obesity on the clinical outcomes and overall morbidities. Methods This retrospective study reviewed the data of all hospitalized trauma patients between 2009 and 2019 and included all patients with surgically proven small bowel, colon, or mesenteric injuries due to a road traffic accident. Comparison of the outcomes was performed among 123 patients with surgically proven BBMI, who were categorized by BMI into the normal-weight (n = 73, BMI<25 kg/m2), overweight (n = 37, 25≤BMI≤30 kg/m2), and obese groups (n = 13, BMI>30 kg/m2). Results The obese group had a significantly lower incidence of isolated bowel injury (0%) compared with the normal-weight (35.6%) and overweight (16.2%) groups (p=0.005), but with higher incidence of isolated mesenteric injury or combined injury, although this was not significant. The obese group (92.3%) had a significantly higher percentage of overall morbidity than the normal-weight (61.6%) and overweight (70.3%) groups (p = 0.047). No significant difference was observed in the in-hospital mortality and 24-hour mortality among the three study groups. Conclusion The study findings do not support the existence of a cushion effect and obesity paradox of obesity in blunt abdominal trauma.
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Affiliation(s)
- Ting-Min Hsieh
- Division of Trauma, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Chun Chuang
- Department of Emergency, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Ting Liu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Bei-Yu Wu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Wei Liu
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Tee YS, Cheng CT, Hsieh CH, Kang SC, Fu CY, Derstine BA, Su GL, Wang SC. Does a "Cushion Effect" Really Exist? A Morphomic Analysis of Vulnerable Road Users with Serious Blunt Abdominal Injury. Healthcare (Basel) 2021; 9:healthcare9081006. [PMID: 34442143 PMCID: PMC8393396 DOI: 10.3390/healthcare9081006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: The severity of injury from motor vehicle crashes (MVCs) depends on complex biomechanical factors, and the bodily features of the injured person account for some of these factors. By assuming that vulnerable road users (VRUs) have limited protection resulting from vehicles and safety equipment, the current study analyzed the characteristics of fat distribution measured by computed tomography (CT) imaging and investigated the existence of a "cushion effect" in VRUs. Materials and Methods: This retrospective study enrolled 592 VRUs involved in MVCs who underwent CT scans. Visceral fat area and subcutaneous fat cross-sectional area were measured and adjusted according to total body area (TBA) and are presented as the visceral fat ratio and the subQ fat ratio (subcutaneous fat ratio). Risk factors for serious abdominal injury (maximum abbreviated injury scale (MAISabd ≥ 3)) resulting from MVCs were determined by univariate and multivariate analysis. Results: MAISabd ≥ 3 was observed in 104 (17.6%) of the patients. The subQ fat ratio at the L4 vertebral level was significantly lower in the MAISabd ≥ 3 group than in the MAISabd < 3 group (24.9 ± 12.0 vs. 28.1 ± 11.9%; p = 0.015). A decreased L4 subQ fat ratio was associated with a higher risk for MAISabd ≥ 3 in multivariate analysis (odds ratio 0.063; 95% CI 0.008-0.509; p = 0.009). Conclusion: The current study supported the "cushion effect" theory, and protection was apparently provided by subcutaneous fat tissue. This concept may further improve vehicle and safety designation in the future.
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Affiliation(s)
- Yu-San Tee
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City 33302, Taiwan; (Y.-S.T.); (C.-T.C.); (C.-H.H.); (S.-C.K.)
| | - Chi-Tung Cheng
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City 33302, Taiwan; (Y.-S.T.); (C.-T.C.); (C.-H.H.); (S.-C.K.)
| | - Chi-Hsun Hsieh
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City 33302, Taiwan; (Y.-S.T.); (C.-T.C.); (C.-H.H.); (S.-C.K.)
| | - Shih-Ching Kang
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City 33302, Taiwan; (Y.-S.T.); (C.-T.C.); (C.-H.H.); (S.-C.K.)
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City 33302, Taiwan; (Y.-S.T.); (C.-T.C.); (C.-H.H.); (S.-C.K.)
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
- Correspondence: ; Tel./Fax: +886-3-3281200 (ext. 2158) or +886-3-3285060
| | - Brian A. Derstine
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI 48109, USA; (B.A.D.); (G.L.S.); (S.C.W.)
| | - Grace L. Su
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI 48109, USA; (B.A.D.); (G.L.S.); (S.C.W.)
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Stewart C. Wang
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI 48109, USA; (B.A.D.); (G.L.S.); (S.C.W.)
- Division of Acute Care Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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Ammori MB, Abu-Zidan FM. The biomechanics of lower limb injuries in frontal-impact road traffic collisions. Afr Health Sci 2018; 18:321-332. [PMID: 30602959 PMCID: PMC6306979 DOI: 10.4314/ahs.v18i2.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim We aimed to review the biomechanics of lower limb injuries caused by frontal-impact road traffic collisions. Methods In this narrative review, we identified articles through pubmed, Scopus and Science Direct search engines for the period of 1990–2014. Search terms included: “biomechanics”, “lower limb injury”, “hip injury”, “knee injury”, “foot and ankle injury” and “frontal impact collision”. We studied factors affecting the anatomical site, frequency and severity of the injuries. Results The most common reported mechanisms of injury were: the impaction of the knee with the dashboard resulting in acetabular fracture or posterior hip dislocation; and toepan intrusion in combination with forceful application of the brake resulting in foot and ankle fractures. The probability of an occupant sustaining significant injury to the hip is increased in taller males, and being out of position during the collision. The probability of an occupant sustaining a fracture to the foot and ankle is increased in shorter female occupants with a large overlap impact or a near oblique collision. Conclusion Understanding the biomechanics of frontal-impact road traffic collisions is useful in alerting clinicians to the potential lower limb injuries sustained in these collisions.
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Affiliation(s)
- Mohannad B Ammori
- School of Engineering, University of Cardiff, United Kingdom; and Royal Gwent Hospital, Newport, United Kingdom
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University,17666 Al-Ain, United Arab Emirates
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Harbaugh CM, Zhang P, Henderson B, Derstine BA, Holcombe SA, Wang SC, Kohoyda-Inglis C, Ehrlich PF. Evaluating the "cushion effect" among children in frontal motor vehicle crashes. J Pediatr Surg 2018. [PMID: 29519566 DOI: 10.1016/j.jpedsurg.2018.02.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The "Cushion Effect," the phenomenon in which obesity protects against abdominal injury in adults in motor vehicle accidents, has not been evaluated among pediatric patients. This work evaluates the association between subcutaneous fat cross-sectional area, quantified using analytic morphomic techniques and abdominal injury. METHODS This retrospective study includes 119 patients aged 1 to 18years involved in frontal impact motor vehicle accidents (2003-2015) with computed tomography scans. Subcutaneous fat cross-sectional area was measured and converted to age- and gender-adjusted percentiles from population-based normative data. Multivariable analysis determined the risk of the primary outcome, Maximum Abbreviated Injury Scale (MAIS) 2+ abdominal injury, after adjusting for age, weight, seatbelt status, and impact rating. RESULTS MAIS 2+ abdominal injuries occurred in 20 (16.8%) of the patients. Subcutaneous fat area percentile was not significantly associated with MAIS 2+ abdominal injury on multivariable logistic regression (adjusted Odds Ratio, 0.86; 95% CI, 0.72-1.03; p=0.10). DISCUSSION The "cushion effect" was not apparent among pediatric frontal motor vehicle crash victims in this study. Future work is needed to investigate other analytic morphomic measures. By understanding how body composition relates to injury patterns, there is a unique opportunity to improve vehicle safety design. LEVEL OF EVIDENCE Prognosis Study, Level III.
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Affiliation(s)
- Calista M Harbaugh
- Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI, United States; Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States.
| | - Peng Zhang
- Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Brianna Henderson
- Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI, United States; Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Brian A Derstine
- Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Sven A Holcombe
- Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Stewart C Wang
- Section of Trauma Burn Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, MI, United States; Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Carla Kohoyda-Inglis
- Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Peter F Ehrlich
- Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital, Ann Arbor, MI, United States; Morphomic Analysis Group, The University of Michigan Medical School, Ann Arbor, MI, United States
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Zhang K, Cao L, Wang Y, Hwang E, Reed MP, Forman J, Hu J. Impact Response Comparison Between Parametric Human Models and Postmortem Human Subjects with a Wide Range of Obesity Levels. Obesity (Silver Spring) 2017; 25:1786-1794. [PMID: 28815943 DOI: 10.1002/oby.21947] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/25/2017] [Accepted: 06/27/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Field data analyses have shown that obesity significantly increases the occupant injury risks in motor vehicle crashes, but the injury assessment tools for people with obesity are largely lacking. The objectives of this study were to use a mesh morphing method to rapidly generate parametric finite element models with a wide range of obesity levels and to evaluate their biofidelity against impact tests using postmortem human subjects (PMHS). METHODS Frontal crash tests using three PMHS seated in a vehicle rear seat compartment with body mass index (BMI) from 24 to 40 kg/m2 were selected. To develop the human models matching the PMHS geometry, statistical models of external body shape, rib cage, pelvis, and femur were applied to predict the target geometry using age, sex, stature, and BMI. A mesh morphing method based on radial basis functions was used to rapidly morph a baseline human model into the target geometry. The model-predicted body excursions and injury measures were compared to the PMHS tests. RESULTS Comparisons of occupant kinematics and injury measures between the tests and simulations showed reasonable correlations across the wide range of BMI levels. CONCLUSIONS The parametric human models have the capability to account for the obesity effects on the occupant impact responses and injury risks.
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Affiliation(s)
- Kai Zhang
- State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, Hunan, China
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
| | - Libo Cao
- State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, Hunan, China
| | - Yulong Wang
- State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, Hunan, China
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
| | - Eunjoo Hwang
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
| | - Matthew P Reed
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
| | - Jason Forman
- Center for Applied Biomechanics, University of Virginia, Charlottesville, Virginia, USA
| | - Jingwen Hu
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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11
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Demand for specialised training for the obese trauma patient: National ATLS expert group survey results. Injury 2017; 48:1058-1062. [PMID: 28262283 DOI: 10.1016/j.injury.2017.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/23/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The growing incidence of obesity in Western populations continues to place new stressors on health systems. Obese trauma patients present particular challenges across the entirety of the patient care pathway, and are at risk of higher lengths of stay, morbidity, and mortality. This study sought to assess a national group of trauma experts' opinions and knowledge regarding the management of obese trauma. METHODS A questionnaire was circulated to a trauma training providers and national steering committee members at a UK national Advance Trauma Life Support meeting. Demographic, knowledge, and opinion data was collected and collated for analysis. RESULTS 109 questionnaires were returned (73% response rate). Broad agreement was reached that obese trauma patients were more challenging to manage (96.2% agreement) and suffered worse outcomes (89.9%). Only 22.2% felt their hospitals possessed appropriate resources to facilitate management. Up to a third of respondents had personally witnesses errors in care due to patient obesity. 90% believed specialist training for obese trauma could improve care. DISCUSSION There is broad consensus amongst UK trauma providers that obese trauma patients are at risk of poorer outcomes and errors in care. Knowledge and preparedness of centres to manage these patients is variable. There was broad consensus that specialist training for the management of obese trauma patients may improve outcomes.
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12
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Kim JE, Hsieh MH, Shum PC, Tubbs RS, Allison DB. Risk and injury severity of obese child passengers in motor vehicle crashes. Obesity (Silver Spring) 2015; 23:644-52. [PMID: 25645729 PMCID: PMC4340813 DOI: 10.1002/oby.21018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/10/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the risk and injury severity on the regional body (head, neck, and chest) of obese children in frontal motor vehicle crashes (MVCs). METHODS No physical surrogates (i.e., crash dummies) for obese children were available, and experiments on pediatric cadavers were generally not feasible. Therefore, computational models of obese children using medical imaging processing and state-of-the-art modeling techniques were developed. A hybrid modeling technique was used to integrate the finite element model for torso fat layer into the standard multibody model to represent various levels of obese children for 3- and 6-year-old age groups. The models were used to investigate injury severity under various crash scenarios through model simulations. RESULTS The head injury criterion and chest acceleration were observed to increase as body mass index (BMI) increased. Meanwhile, no such correlations were found between BMI and neck injury and chest deformation. Forward head and torso excursions were observed to increase as obesity increased, owing to the momentum effect of greater body mass. CONCLUSIONS Obese children appeared to have greater risks for head and chest injuries than do their non-obese counterparts in frontal MVCs, owing to higher head and chest accelerations induced by greater body excursion.
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Affiliation(s)
- Jong-Eun Kim
- Department of Mechanical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Min-Heng Hsieh
- Department of Mechanical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Phillip C. Shum
- Department of Mechanical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - R. Shane Tubbs
- Pediatric Neurosurgery, Children’s of Alabama, Birmingham, AL 35294, USA
| | - David B. Allison
- Nutrition Obesity Research Center, University of Alabama at Birmingham, AL 35294, USA
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Shi X, Cao L, Reed MP, Rupp JD, Hu J. Effects of obesity on occupant responses in frontal crashes: a simulation analysis using human body models. Comput Methods Biomech Biomed Engin 2014; 18:1280-92. [DOI: 10.1080/10255842.2014.900544] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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