A. Santoro1, E. Otoo1, A. Salami1, R. Smith2, A. Joshi1 1Albert Einstein Medical Center,Surgery,Philadelphia, PENNSYLVANIA, USA 2Albert Einstein Medical Center,Radiology,Philadelphia, PENNSYLVANIA, USA
Introduction: Sarcopenia is the age-related loss of skeletal muscle mass. Studies have described a correlation between sarcopenia, frailty, and poor outcomes in heterogeneous populations. We sought to determine the utility of psoas muscle area index (PAI), a new tool for the assessment of sarcopenia, in predicting poor outcomes amongst trauma patients.
Methods: This retrospective observational study was conducted using data from the trauma database at Albert Einstein Medical Center, a level 1 trauma center in Philadelphia, PA. All level 1 & 2 trauma activations for blunt and penetrating trauma between September 2014 and December 2015 were included. Patients without abdominal CT scans at the time of initial presentation were excluded. CT scans of the abdomen were used in estimating PAI at the level of the 3rd lumbar vertebral body using the formula [psoas muscle area(mm2)/height(m2)]. PAI was dichotomized with values < the 25th percentile representing the sarcopenic group, while ICU and hospital length of stay (LoS) were dichotomized with values > the 75th percentile representing prolonged stay. Outcomes of interest were in-hospital mortality, prolonged ICU, and Hospital LoS. Multivariable logistic regression was used in elucidating associations.
Results: A total of 254 patients were included in this study, 73 (28.7%) were aged>65 years and 111 (43.7%) were female. In-hospital mortality occurred in 13 patients (5.2%). Prolonged ICU and hospital LoS were observed in 22.8% and 24% of the study population, respectively. PAI was not associated with in-hospital mortality (OR: 0.5, CI: 0.12-2.49; p=0.426), prolonged ICU (OR: 0.95, CI: 0.48-1.89; p=0.894), or hospital LoS (OR: 1.3, CI: 0.68-2.46; p=0.425) on univariate analyses. This trend persisted following multivariable adjustment (p>0.05 for all). Similarly, PAI was not found to be predictive of outcomes following stratification by age (above or below 65 years) and gender.
Conclusion: PAI does not seem to have any correlation with poor outcomes in trauma patients, irrespective of age or gender. Prospective studies with larger populations are needed to determine if PAI has any prognostic utility in the risk stratification of trauma patients.