Section of General, Thoracic, and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, Washington2Division of Gerontology and Geriatric Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle.
Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, Harborview Medical Center, University of Washington, Seattle.
JAMA Surg. 2017 Feb 15;152(2):e164604. doi: 10.1001/jamasurg.2016.4604.
Assessment of physical frailty in older trauma patients admitted to the intensive care unit is often not feasible using traditional frailty assessment instruments. The use of opportunistic computed tomography (CT) scans to assess sarcopenia and osteopenia as indicators of underlying frailty may provide complementary prognostic information on long-term outcomes.
To determine whether sarcopenia and/or osteopenia are associated with 1-year mortality in an older trauma patient population.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort constructed from a state trauma registry was linked to the statewide death registry and Comprehensive Hospital Abstract Reporting System for readmission data analyses. Admission abdominopelvic CT scans from patients 65 years and older admitted to the intensive care unit of a single level I trauma center between January 2011 and May 2014 were analyzed to identify patients with sarcopenia and/or osteopenia. Patients with a head Injury Severity Score of 3 or greater, an out-of-state address, or inadequate CT imaging or who died within 24 hours of admission were excluded.
Sarcopenia and/or osteopenia, assessed via total cross-sectional muscle area and bone density at the L3 vertebral level, compared with a group with no sarcopenia or osteopenia.
One-year all-cause mortality. Secondary outcomes included 30-day all-cause mortality, 30-day readmission, hospital length of stay, hospital cost, and discharge disposition.
Of the 450 patients included in the study, 269 (59.8%) were male and 394 (87.6%) were white. The cohort was split into 4 groups: 74 were retrospectively diagnosed with both sarcopenia and osteopenia, 167 with sarcopenia only, 48 with osteopenia only, and 161 with no radiologic indicators. Among the 408 who survived to discharge, sarcopenia and osteopenia were associated with higher risks of 1-year mortality alone and in combination. After adjustment, the hazard ratio was 9.4 (95% CI, 1.2-75.4; P = .03) for sarcopenia and osteopenia, 10.3 (95% CI, 1.3-78.8; P = .03) for sarcopenia, and 11.9 (95% CI, 1.3-107.4; P = .03) for osteopenia.
More than half of older trauma patients in this study had sarcopenia, osteopenia, or both. Each factor was independently associated with increased 1-year mortality. Given the prevalent use of abdominopelvic CT in trauma centers, opportunistic screening for radiologic indicators of frailty provides an additional tool for early identification of older trauma patients at high risk for poor outcomes, with the potential for targeted interventions.
在入住重症监护病房的老年创伤患者中，使用传统的衰弱评估工具评估身体虚弱往往是不可行的。利用机会性计算机断层扫描（CT）评估肌肉减少症和骨质疏松症作为潜在虚弱的指标，可能会提供关于长期预后的补充预后信息。
确定肌肉减少症和/或骨质疏松症是否与老年创伤患者群体的 1 年死亡率相关。
设计、地点和参与者：从州创伤登记处构建的回顾性队列与全州死亡登记处和综合医院摘要报告系统相连接，以进行再入院数据分析。对 2011 年 1 月至 2014 年 5 月期间在单一 1 级创伤中心入住重症监护病房的 65 岁及以上患者的腹部骨盆 CT 扫描进行分析，以确定患有肌肉减少症和/或骨质疏松症的患者。排除头部损伤严重程度评分大于等于 3、州外地址、CT 成像不足或入院后 24 小时内死亡的患者。
通过 L3 椎体水平的总横截面积肌肉面积和骨密度评估的肌肉减少症和/或骨质疏松症，与无肌肉减少症或骨质疏松症的组进行比较。
1 年全因死亡率。次要结局包括 30 天全因死亡率、30 天再入院、住院时间、住院费用和出院去向。
在纳入研究的 450 名患者中，269 名（59.8%）为男性，394 名（87.6%）为白人。该队列分为 4 组：74 名患者回顾性诊断为同时患有肌肉减少症和骨质疏松症，167 名患者仅患有肌肉减少症，48 名患者仅患有骨质疏松症，161 名患者无放射学指标。在 408 名存活至出院的患者中，肌肉减少症和骨质疏松症单独或联合存在与 1 年死亡率升高相关。调整后，肌肉减少症和骨质疏松症的风险比为 9.4（95%CI，1.2-75.4；P=0.03），肌肉减少症的风险比为 10.3（95%CI，1.3-78.8；P=0.03），骨质疏松症的风险比为 11.9（95%CI，1.3-107.4；P=0.03）。
在这项研究中，超过一半的老年创伤患者患有肌肉减少症、骨质疏松症或两者兼有。每个因素都与 1 年死亡率的增加独立相关。鉴于在创伤中心普遍使用腹部骨盆 CT，机会性筛查衰弱的放射学指标为识别预后不良风险较高的老年创伤患者提供了另一种工具，可能会有针对性地进行干预。
