Lauerman Margaret H, Raithel Maxwell, Kufera Joseph, Shanmuganathan Kathirkamanathan, Bruns Brandon R, Scalea Thomas M, Stein Deborah M
Division of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, 22 South Greene St, Baltimore, MD, 21201, USA.
Injury. 2019 Jan;50(1):149-155. doi: 10.1016/j.injury.2018.11.004. Epub 2018 Nov 3.
Clinical frailty scores usually involve questionnaires or physical testing. Many trauma patients are not able to participate in these. Radiographic measurement of frailty may be a viable alternative. Individual radiographic markers of frailty have been investigated, such as sarcopenia or osteopenia. The ideal radiographic variable (or variables) to measure frailty in trauma is unknown.
A retrospective review was performed of restrained drivers ages 40 and greater at a single institution from 2010-2015. Multiple markers of radiographic frailty were measured including: sarcopenia, osteopenia, vascular calcifications, sarcopenic obesity, emphysema, renal volume, cervical spine degeneration, and cerebral atrophy. Frailty was defined as the worst quartile for each radiographic variable, and these values were summed to create a composite marker of frailty. The primary outcome was discharge disposition. We hypothesized that a composite frailty score would be associated with discharge disposition while individual markers would not be associated with discharge disposition.
Overall 489 patients were included in this study. Cerebral atrophy (p = 0.05), renal volume (p = 0.004), sarcopenia (p = 0.05), vascular calcifications (p = 0.02) and sarcopenic obesity (p = 0.01) were associated with discharge disposition. Pearson's correlation coefficients between radiographic frailty markers were all less than 0.4. Youden's Index was 0.26 (p < 0.001) at a composite score of 3. In multivariable analysis, the composite score of 3 or greater was associated with poor discharge disposition (OR 2.39, 95% CI 1.10-5.18, p = 0.03).
Individual radiographic frailty markers are inadequate markers of frailty, as they may miss patients who are frail. This study also suggests that a composite radiographic frailty score may better predict patient outcome than individual radiographic markers of frailty.
临床衰弱评分通常涉及问卷调查或身体检查。许多创伤患者无法参与这些。通过影像学测量衰弱程度可能是一种可行的替代方法。已经对衰弱的个体影像学标志物进行了研究，如肌肉减少症或骨质减少。用于测量创伤患者衰弱程度的理想影像学变量（或变量组合）尚不清楚。
对2010年至2015年在单一机构中年龄40岁及以上的受约束驾驶员进行了回顾性研究。测量了多个影像学衰弱标志物，包括：肌肉减少症、骨质减少、血管钙化、肌肉减少性肥胖、肺气肿、肾体积、颈椎退变和脑萎缩。衰弱被定义为每个影像学变量的最差四分位数，将这些值相加以创建一个综合衰弱标志物。主要结局是出院处置情况。我们假设综合衰弱评分与出院处置情况相关，而个体标志物与出院处置情况无关。
本研究共纳入489例患者。脑萎缩（p = 0.05）、肾体积（p = 0.004）、肌肉减少症（p = 0.05）、血管钙化（p = 0.02）和肌肉减少性肥胖（p = 0.01）与出院处置情况相关。影像学衰弱标志物之间的Pearson相关系数均小于0.4。综合评分为3分时，约登指数为0.26（p < 0.001）。在多变量分析中，综合评分3分及以上与不良出院处置情况相关（OR 2.39，95%CI 1.10 - 5.18，p = 0.03）。
个体影像学衰弱标志物不足以作为衰弱的标志物，因为它们可能会遗漏衰弱患者。本研究还表明，综合影像学衰弱评分可能比个体影像学衰弱标志物能更好地预测患者结局。
