Elsevier

Surgery

Volume 162, Issue 2, August 2017, Pages 377-384
Surgery

Trauma/Critical care
Computed tomography measured psoas density predicts outcomes in trauma

https://doi.org/10.1016/j.surg.2017.03.014Get rights and content

Background

Age-related loss of muscle mass and function (sarcopenia) is linked to poor outcomes after operation and trauma. Here we evaluate computed tomography measured psoas muscle density and area using quick and simple tools available to the bedside clinician. We hypothesize these measures will predict poor outcomes after blunt traumatic injury.

Methods

We conducted a retrospective cohort study of patients ages ≥45 years in the Ohio State University Trauma Registry in 2008 that received a computed tomographic scan of the abdomen and/or pelvis with intravenous contrast. Psoas Index and Hounsfield unit average calculation were measured at the L3 level. In the study, 90-day mortality, complication, duration of stay ≥7 days, and dependent discharge were compared with Psoas Index and Hounsfield unit average calculation.

Results

In the study, 151 patients met the inclusion criteria. Patients were stratified into interquartile ranges based either on Psoas Index or Hounsfield unit average calculation values. After adjustment with sex-specific cutoffs, the lowest interquartile range of Psoas Index was associated with 90-day mortality (relative risk [RR] 5.95, P < .008), but did not reach significance in other outcomes. The lowest interquartile range of Hounsfield unit average calculation was associated with 90-day mortality (RR 5.95, P < .008), duration of stay ≥ 7 days (RR 1.63, P = .048), complication risk (RR 2.30, P = .002), and dependent discharge 2.14, P = .015).

Conclusion

Psoas muscle density is a significant predictor of poor outcomes after traumatic injury. This objective, quick, and readily available measure of sarcopenia can identify patients requiring aggressive nutritional and physical therapy to improve prognosis, prevent recurrent traumatic injury, and aid in discharge planning.

Section snippets

Data source and patient characteristics

We reviewed the Ohio State University Trauma Registry for patients aged ≥45 years with blunt mechanism of trauma that underwent evaluation between January 1, 2008 and December 31, 2008 with CT abdomen/pelvis with venous contrast during the initial trauma evaluation. For each patient record, detailed clinical variables were collected including age, sex, body mass index (BMI), independent status before trauma, mechanism of trauma, presenting Glasgow Coma Scale Score, Injury Severity Score, number

Baseline patient characteristics

We stratified patients into interquartile ranges based on either their psoas area or psoas density (Supplementary Table I). Our muscle density cutoff for sarcopenia was defined as the 25th percentile value of HUAC (sarcopenia by HUAC ≤38.5 HU). Given the significant sex-specific difference in PI, our muscle size specific cutoff was defined as the 25th percentile value of PI by sex (sarcopenia by PI, male ≤7.77 cm2/m2, female ≤4.75 cm2/m2). We categorized complications by a set list (

Discussion

Frailty is recognized as a significant contributor to age-related morbidity and mortality. However, there remains no standardized definition or method to identify the representative pathologic loss of physiologic reserve. Current methods often rely on measures in the patient history and functional tests that are reliant on patient effort. The subjective nature and variability of these metrics, as well as the time-consuming nature in gathering them may limit their clinical utility.4, 5, 6, 7

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  • Cited by (0)

    T.Y. is the recipient of National Institute of Allergy and Infectious Diseases of the National Institutes of Health under award number NIH T32AI 106704-01A1. W.L. is the recipient of an Ohio State University College of Medicine Roessler Research Scholarship.

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