Obesity Protects Against Operation in Pediatric Penetrating Trauma to the Torso

Published:February 24, 2021DOI:



      Studies in the adult population are conflicting regarding whether obesity is protective in penetrating trauma. In the pediatric population, data on obesity and penetrating trauma are limited. We sought to determine if there is a different rate of operation or of survival in pediatric and adolescent patients with obesity.


      We queried the National Trauma Data Bank research data set from 2013 to 2016 for all patients aged 2-18 who sustained traumatic penetrating injuries to the thorax and abdomen. The cohort was divided into body mass index percentiles for gender and age using Center for Disease Control definitions. Outcomes included overall survival, whether or not an operative procedure was performed, and hospital and intensive care unit (ICU) length of stay.


      We analyzed 9611 patients with penetrating trauma, of which 4285 had an operative intervention. When adjusted for other variables (age, gender, race, ICU length of stay, hospital length of stay, and Injury Severity Score), children of every body mass index percentile had similar survival. Healthy weight patients were more likely to get an operation than patients in the obese category. Length of hospital stay was similar between groups, but the ICU length of stay was longer in the overweight and obese groups compared with healthy weight and underweight groups.


      Children and adolescents with obesity are less likely to undergo operation after penetrating thoracoabdominal trauma. Further study is needed to determine the reason for this difference.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ogden C.L.
        • Carroll M.D.
        • Lawman H.G.
        • et al.
        Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014.
        JAMA. 2016; 315: 2292-2299
        • Center for Disease Control
        (Available at:)
        Date accessed: January 9, 2020
        • Skinner A.C.
        • Perrin E.M.
        • Skelton J.A.
        Prevalence of obesity and severe obesity in US children, 1999-2014.
        Obesity (Silver Spring). 2016; 24: 1116-1123
        • Skinner A.C.
        • Ravanbakht S.N.
        • Skelton J.A.
        • Perrin E.M.
        • Armstrong S.C.
        Prevalence of obesity and severe obesity in US children, 1999-2016.
        Pediatrics. 2018; 141: e20173459
        • Rana A.R.
        • Michalsky M.P.
        • Teich S.
        • Groner J.I.
        • Caniano D.A.
        • Schuster D.P.
        Childhood obesity: a risk factor for injuries observed at a level-1 trauma center.
        J Pediatr Surg. 2009; 44: 1601-1605
        • Alselaim N.
        • Malaekah H.
        • Saade M.
        • et al.
        Does obesity impact the pattern and outcome of trauma in children?.
        J Pediatr Surg. 2012; 47: 1404-1409
        • Pomerantz W.J.
        • Timm N.L.
        • Gittelman M.A.
        Injury patterns in obese versus nonobese children presenting to a pediatric emergency department.
        Pediatrics. 2010; 125: 681-685
        • Ashley P.
        • Gilbert S.R.
        Obesity in pediatric trauma.
        Orthop Clin North Am. 2018; 49: 335-343
        • Witt C.E.
        • Arbabi S.
        • Nathens A.B.
        • Vavilala M.S.
        • Rivara F.P.
        Obesity in pediatric trauma.
        J Pediatr Surg. 2017; 52: 628-632
        • Brown C.V.
        • Neville A.L.
        • Salim A.
        • Rhee P.
        • Cologne K.
        • Demetriades D.
        The impact of obesity on severely injured children and adolescents.
        J Pediatr Surg. 2006; 41 (discussion 88-91): 88-91
        • Backstrom I.C.
        • MacLennan P.A.
        • Sawyer J.R.
        • Creek A.T.
        • Rue L.W.
        • Gilbert S.R.
        Pediatric obesity and traumatic lower-extremity long-bone fracture outcomes.
        J Trauma Acute Care Surg. 2012; 73: 966-971
        • Vaughan N.
        • Tweed J.
        • Greenwell C.
        • et al.
        The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center.
        J Pediatr Surg. 2017; 52: 345-348
      1. National Trauma Data Bank. American College of Surgeons Committee on Trauma: Chicago, IL.

        • McGaha P.
        • Stewart K.
        • Garwe T.
        • Johnson J.
        • Sarwar Z.
        • Letton R.W.
        Is it time for firearm injury to be a separate activation criteria in children? An assessment of penetrating pediatric trauma using need for surgeon presence.
        Am J Surg. 2021; 221: 21-24
        • Nash N.
        • Kimbrough C.W.
        • Mackowski M.
        • et al.
        Is obesity protective in thoracoabdominal penetrating trauma?.
        Am Surg. 2019; 85: 34-38
        • Barlow S.E.
        • Expert C.
        Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.
        Pediatrics. 2007; 120 Suppl 4: S164-S192
      2. A SAS program for the 2000 CDC growth charts (ages 0 to <20 years).
        (Available at:)
        • Arbabi S.
        • Wahl W.L.
        • Hemmila M.R.
        • Kohoyda-Inglis C.
        • Taheri P.A.
        • Wang S.C.
        The cushion effect.
        J Trauma. 2003; 54: 1090-1093
        • Abhyankar S.
        • Leishear K.
        • Callaghan F.M.
        • Demner-Fushman D.
        • McDonald C.J.
        Lower short- and long-term mortality associated with overweight and obesity in a large cohort study of adult intensive care unit patients.
        Crit Care. 2012; 16: R235
        • Shah S.R.
        • Wearden P.D.
        • Gaines B.A.
        Pediatric peripheral vascular injuries: a review of our experience.
        J Surg Res. 2009; 153: 162-166