Wu Liang, Li Yunfei, Sun Meng, Yao Nanyu, Zhang Zhaofeng, Liu Weiming
Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University Beijing China.
Department of Nutrition and Food Hygiene, School of Public Health Peking University Beijing China.
Aging Med (Milton). 2025 Aug 14;8(4):294-302. doi: 10.1002/agm2.70040. eCollection 2025 Aug.
Mild traumatic brain injury (mTBI) in older patients is a common condition in neurosurgery, often linked to poor long-term outcomes, especially when accompanied by frailty. Sarcopenia contributes to this frailty and can be assessed through transverse imaging methods. This study aimed to assess the prognostic value of the masseter muscle cross-sectional area (MCSA) as determined from admission CT head scans in older patients with mTBI.
This retrospective study identified older patients with mTBI who were admitted to our hospital from April 2013 to December 2022. The Glasgow Outcome Scale Extended (GOSE) was utilized to assess neurological outcomes at 6 months follow-up, which were divided into complete recovery (GOSE = 8) and incomplete recovery (GOSE ≤ 7). We measured the average MCSA using admission CT scans and evaluated the consistency of these measurements. Multivariable logistic regression was conducted to evaluate the association between reduced MCSA and 6-month clinical outcomes in older mTBI patients while adjusting for age, gender, and comorbidity.
The study involved 227 patients, 135 (59.5%) males and 92 (40.5%) females, with a mean age of 74.1 years. 92 (40.5%) had an adverse clinical outcome by the end of follow-up. The intra- and inter-observer reliability of the MCSA measurements was good to excellent (ICCs = 0.955-0.972 and 0.856-0.892). MCSA decreased with age (Pearson's = -0.290, < 0.001). Males had higher MCSA than females ( < 0.001). The optimal MCSA cutoff values for predicting 6-month clinical outcomes were 358.75 mm for male and 263.25 mm for female patients. Reduced MCSA was associated with 6-month clinical outcomes in univariate and multivariate logistic analyses (OR = 0.131, 95% CI: 0.063-0.273; < 0.001). The MCSA was linearly associated with incomplete recovery ( < 0.001, P for nonlinear = 0.127).
MCSA measurements from initial scans were reliable, providing prognostic information that supplemented existing predictors of poor outcomes in older mTBI patients.
老年患者的轻度创伤性脑损伤（mTBI）是神经外科的常见病症，常与不良的长期预后相关，尤其是伴有身体虚弱时。肌肉减少症会导致身体虚弱，可通过横向成像方法进行评估。本研究旨在评估从入院时头部CT扫描确定的咬肌横截面积（MCSA）对老年mTBI患者的预后价值。
这项回顾性研究纳入了2013年4月至2022年12月期间我院收治的老年mTBI患者。采用格拉斯哥扩展预后量表（GOSE）评估6个月随访时的神经功能预后，分为完全恢复（GOSE = 8）和不完全恢复（GOSE≤7）。我们使用入院时的CT扫描测量平均MCSA，并评估这些测量的一致性。进行多变量逻辑回归分析，以评估在调整年龄、性别和合并症的情况下，MCSA降低与老年mTBI患者6个月临床预后之间的关联。
该研究共纳入227例患者，其中男性135例（59.5%），女性92例（40.5%），平均年龄74.1岁。92例（40.5%）在随访结束时出现不良临床预后。MCSA测量的观察者内和观察者间可靠性良好至优秀（组内相关系数=0.955 - 0.972和0.856 - 0.892）。MCSA随年龄增长而降低（Pearson相关系数=-0.290，P<0.001）。男性的MCSA高于女性（P<0.001）。预测6个月临床预后的最佳MCSA临界值，男性为358.75mm，女性为263.25mm。在单变量和多变量逻辑分析中，MCSA降低与6个月临床预后相关（比值比=0.131，95%置信区间：0.063 - 0.273；P<0.001）。MCSA与不完全恢复呈线性相关（P<0.001，非线性P值=0.127）。
初次扫描的MCSA测量结果可靠，可提供预后信息，补充老年mTBI患者不良预后的现有预测指标。
