Is elevated body mass index protective against cervical spine injury in adults?
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Correlate body mass index (BMI) with incidence and type of cervical spine injury seen on CT in adult patients presenting with blunt trauma.
Materials and methods
Retrospective chart review of all adult blunt trauma patients who had a cervical spine CT performed at our level 1 trauma center during an approximately 3-year period.
A statistically significant (p = 0.01) difference in cervical spine injury incidence was present between different BMI groups. Cervical spine injury incidence was 7.7% for underweight (BMI ≤ 18) patients, 7.1% for normal weight (BMI 18–25) patients, 6.2% for overweight/obese (BMI 25–35) patients, and 4.7% for morbidly obese (BMI > 35) patients. Using BMI > 18–25 as a reference group, females with BMI > 25–35 had an adjusted odds ratio (aOR) of 0.56 (CI 0.41–0.75) and females with BMI > 35 had an aOR of 0.42 (CI 0.26–0.70). Males with a BMI ≤ 18 had an aOR of 2.20 (CI 1.12–4.32) and males with BMI > 35 had an aOR of 0.66 (CI 0.46–0.95). A particularly low incidence of cervical spine injury was observed in patients older than 65 in the obese group with a cervical spine injury rate of only 1.4% in this patient population. No statistical significant difference was seen in injury morphology across the BMI groups.
An inverse relationship exists between BMI and the overall incidence of cervical spine injury. This protective effect appears to be influenced by gender with elevated BMI having lower relative odds of cervical spine injury in women than in men. A particularly low rate of cervical spine injury was identified in obese patients over the age of 65. Routine imaging of all elderly, obese trauma patients with low energy mechanism of injury may not be warranted.
KeywordsCervical spine Trauma Injury Body mass index Obesity
1. Memorial Hospital System in Houston.
2. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design (BERD) component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by a grant (UL1 TR000371) from the National Center for Advancing Translational Sciences (NCATS), awarded to University of Texas Health Science Center at Houston. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCATS.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Ogden CL, Carroll MD, Fryar CD, Flegal KM (2015) Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief 219:1–8Google Scholar
- 11.Prieto-Alhambra D, Premaor MO, Fina Aviles F, Hermosilla E, Martinez-Laguna D, Carbonell-Abella C, Nogues X, Compston JE, Diez-Perez A (2012) The association between fracture and obesity is site-dependent: a population-based study in postmenopausal women. J Bone Miner Res 27(2):294–230CrossRefPubMedGoogle Scholar
- 12.Compston JE, Watts NB, Chapurlat R, Cooper C, Boonen S, Greenspan S, Pfeilschifter J, Silverman S, Diez-Perez A, Lindsay R, Saag KG, Netelenbos JC, Gahlbach S, Hooven FH, Flahive J, Adachi JD, Rossini M, Lacroix AZ, Roux C, Sambrook PN, Siris ES, Glow Investigators (2014) Obesity is not protective against fracture in postmenopausal women: GLOW. Am J Med 124(11):1043–1050CrossRefGoogle Scholar
- 34.De Laet C, Kanis JA, Odén A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ 3rd, Meunier PJ, Pols HA, Reeve J, Silman A, Tenenhouse A (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338CrossRefPubMedGoogle Scholar
- 38.Nielson CM, Marshall LM, Adams AL, LeBlanc ES, Cawthon PM, Ensrud K, Stefanick ML, Barrett-Connor E, Orwoll ES, for the Osteoporotic Fractures in Men Study (MrOS) Research Group, Osteoporotic Fractures In Men Study Research Group (2011) BMI and fracture risk in older men: the osteoporotic fractures in men study. J Bone Miner Res 26(3):496–502CrossRefPubMedGoogle Scholar
- 39.Bachmann KN, Bruno AG, Bredella MA, Schorr M, Lawson EA, Gill CM, Singhal V, Meenaghan E, Gerweck AV, Eddy KT, Ebrahimi S, Koman SL, Greenblatt JM, Keane RJ, Weigel T, Dechant E, Misra M, Klibanski A, Bouxsein ML, Miller KK (2016 Feb) Vertebral strength and estimated fracture risk across the BMI spectrum in women. J Bone Miner Res 31(2):281–288CrossRefPubMedGoogle Scholar
- 41.Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, de Maio VJ, Laupacis A, Schull M, McKnight R, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I, Morrison L, Reardon M, Worthington J (2001) The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 286(15):1841–1848CrossRefPubMedGoogle Scholar