Computed tomography abbreviated assessment of sarcopenia following trauma

Abstract

Background Older adult trauma patients are at increased risk of poor outcome, both immediately after injury and beyond hospital discharge. Identifying patients early in the hospital stay who are at increased risk of death after discharge can be challenging. Methods Retrospective analysis was performed using our trauma registry linked with the social security death index from 2010–2014. Age was categorized by 18–64 and ≥65 years. We calculated mortality rates by age category then selected elderly patients with mechanism of injury being a fall for further analysis. CT Abbreviated Assessment of Sarcopenia for Trauma (CAAST) was obtained by measuring psoas muscle cross-sectional area adjusted for height and weight. Kaplan-Meier survival analysis was performed and proportional hazards regression modeling was utilized to determine independent risk factors for in-hospital and out-of-hospital mortality. Results 23,622 patients were analyzed (age 18–64: 16,748 and age≥65: 6,874). In-hospital mortality was 1.96% for age 18–64 and 7.19% for age ≥65 (p<0.001); post-discharge 6-month mortality was 1.1% for age 18–64 and 12.86% for age ≥65 (p<0.001). Predictors of in-hospital and post-discharge mortality for age 18–64 and in-hospital mortality for age≥65 group included injury characteristics such as ISS, admission vitals and head injury. Predictors of post-discharge mortality for age ≥65 included skilled nursing prior to admission, disposition, and mechanism of injury being a fall. In total, 57.5% (n=256) of older patients who sustained a fall met criteria for sarcopenia. Sarcopenia was the strongest predictor of out-of-hospital mortality in this cohort with hazard ratio 4.77 (95% CI 2.71–8.40; p<0.001) Conclusion Out of hospital does not assure out of danger for the elderly. Sarcopenia is a strong predictor of 6-month post-discharge mortality for older adults. The CAAST measurement is an efficient and inexpensive measure that can allow clinicians to target older trauma patients at risk of poor outcome for early intervention and/or palliative care services.

Radiographic assessment of sarcopenia in the trauma setting: a systematic review

“…Studies like Chang et al 21 calculated SMI using lean muscle mass, obtained by setting density thresholds to exclude fatty infiltrate in the imaging software used to calculate CSA. A more holistic approach was taken by Leeper et al , normalizing psoas CSA using a calculated value for body surface area (BSA) 6. Akahoshi et al similarly used calculated BSA to generate an estimate for psoas CSA, and defined sarcopenia as a difference between estimate and actual psoas CSA 22…”

“…Sarcopenia is characterized by loss of skeletal muscle, decreased muscle strength and low physical performance 4. It has been demonstrated that the presence of sarcopenia is a marker for poor outcome in the elderly with a critical illness5 or traumatic injury 6 7. These patients therefore may require modification and personalization of care and interventions to counteract the increased likelihood of adverse health events 8.…”

Clinically Practical Approach for Screening of Low Muscularity Using Electronic Linear Measures on Computed Tomography Images in Critically Ill Patients

“…Also, low psoas CSA in relation to L4 vertebra size is associated with an increased risk for complications during hospital stay . Importantly, low muscularity as determined by measuring psoas CSA using abdominal CT scans recently emerged as a predictor of mortality in elderly trauma patients . On the other hand, CSA of the paraspinal muscles, determined using MRI, is reported to decrease following prolonged bed rest in healthy adults .…”

“…7 Importantly, low muscularity as determined by measuring psoas CSA using abdominal CT scans recently emerged as a predictor of mortality in elderly trauma patients. 5,6 On the other hand, CSA of the paraspinal muscles, determined using MRI, is reported to decrease following prolonged bed rest in healthy adults. 9 Although our work demonstrated that linear measures of the paraspinal muscles yielded less variability and a stronger correlation with total L3 muscle CSA compared with the psoas muscle group, the combined linear measures products of psoas and paraspinal muscles exhibited a stronger correlation and a greater ability to correctly identify patients with low skeletal muscle index values.…”

Screening for low muscularity in colorectal cancer patients: a valid, clinic‐friendly approach that predicts mortality

“…Abbreviated methods to screen for low muscle from routine CT imaging have been proposed in intensive care and trauma populations,24 and to a limited extent in cancer patients, where results have been mixed 25, 26. One recently proposed method27 allows the user to quickly assess patient muscularity using the combined area of the psoas and paraspinal muscles computed from linear measurements that take <2 min per patient.…”