F. Cai1, J. C. Lee2, E. J. Matta4, C. E. Wade1,3, S. D. Adams1,3 1McGovern Medical School,Surgery,Houston, TX, USA 2Memorial Hermann Hospital,Clinical Nutrition,Houston, TX, USA 3Center for Translational Injury Research,Houston, TX, USA 4McGovern Medical School,Diagnostic Radiology,Houston, TX, USA
Introduction:
More than 2 million people are hospitalized in the US annually for traumatic injuries. These patients are at risk for malnutrition due to prolonged preoperative fasting and minimal intake due to ileus or intestinal injury, and their injuries increase metabolic demands. The gold standard diagnosis for malnutrition is a dietician interview and physical exam to assess ASPEN/AND malnutrition consensus criteria. Weight loss, loss of muscle mass and fat are commonly used as indicators, along with calorie intake history, however, this requires time, resources and training. Given the prevalence and accessibility of CT imaging in trauma admissions, morphometric analysis has the potential to be an indicator of admission nutritional status. We hypothesized that admission CT scans can identify individuals at high risk of being malnourished on arrival, and this early identification can target them for aggressive nutrition supplementation.
Methods:
We did a retrospective review of adult (>15 years) patients with traumatic injuries admitted to our level I trauma center. We included patients with admission abdominal CT scans and a dietician nutritional assessment within 3 days. Patients were stratified by gender, age (Young<65 years, Older≥65 years), and nutritional status, designated as non-malnourished (NM) or moderate-severe malnourished (MSM). CT images were analyzed using Aquarius TeraRecon software to calculate the average psoas area at the level of 4-5th lumbar disc. Statistical significance was determined by stepwise selection modeling and set at p<0.05.
Results:
Images were analyzed in 120 patients, of which 58% were male. The mean age was 53.6 ± 21.6 and 37% were Older (n=44). The median average psoas area in NM Young males (n=47) was 18.6 cm2, compared to a median of 12.9 cm2 in the MSM. For Young females (n=29), the medians were 10.6 cm2 in the NM and 9.2 cm2 in the MSM. When looking at the older population, Older males (n=23), had a median of 12.1 cm2 in the NM and 9.7 cm2 in the MSM. Older females (n=21) had a median of 8.4 cm2 in the NM and 6.6 cm2 in the MSM. (IQ ranges in box plot graph.) With stepwise selection modeling, we found that gender and psoas size each had a significant effect on the nutritional status. Age by psoas size demonstrated an interaction on nutritional status, but did not reach significance.
Conclusion:
Our data show that average psoas area significantly decreases in patients diagnosed with malnutrition. Gender is also associated with a significant increased risk in having malnutrition. In trauma patients with admit CT scans, psoas area analysis can potentially be used to trigger a more aggressive nutrition supplementation plan upon admission, even before dietician assessment.
