D. Proksch1, K. Kelley1, S. Shaw1, J. Burgess1 1Eastern Virginia Medical School,Norfolk, VA, USA
Introduction: Relative to the general population, trauma injuries in elderly patients are linked to increased incidence of morbidity and mortality. A previously reported surrogate measure of sarcopenia is psoas muscle size—an established predictor of in-hospital outcomes, but its association with long term outcomes is unknown. The purpose of this prospective study is to assess the predictive power of psoas muscle size on functional status and survival of elderly trauma patients 3 and 6 months after intensive care unit admission.
Methods: Trauma intensive care unit patients over the age of 50 were recruited to the study. The patient or their caregiver completed a questionnaire regarding pre-admission functional status. Attendings, residents, and nurses completed prognostic surveys regarding their patient’s 3 and 6-month survival and disposition. Chart review included cross-sectional psoas area measurements on computerized tomography scan which were used to stratify patients into sarcopenic and non?sarcopenic groups. Finally, patients received phone calls 3 and 6 months post-trauma to determine overall health and functional status.
Results: The 72 study participants had an average age of 70 and a corrected psoas area of 388 ± 101 mm2/m2. Sarcopenia was defined as below the study median (380 mm2/m2). Injury Severity Score distribution was similar for the sarcopenic and non?sarcopenic groups (17.7 ± 9.2). Patients also had similar pre-injury activities of daily living, walking device use, and co-morbidities. Sarcopenic patients had a higher incidence of recent weight loss (p=0.009). Hospital courses were similar except that non?sarcopenic patients were more likely to go to the operating room at least once (p=0.0007). Forty-one and twenty?six patients completed a phone survey at 3 and 6 months, respectively. There was not a significant difference in overall health, independence, and hospital re-admission. Medical provider surveys predicted that the sarcopenic patients would be less likely to survive 3 and 6 months post-trauma (p<0.05). Six-month survival prediction accuracy was the same for both groups (p=0.95). In-hospital mortality was not statistically significant but trended toward an increase in the sarcopenic patients (9% vs. 19%, p=0.22); 3-month mortality showed similar trends (14% vs. 24%, p=0.29).
Conclusion: While sarcopenia has a reported association with worse outcomes in elderly trauma patients, our prospective study did not show a significant difference in complication rates during hospitalization. It is unclear why sarcopenic patients were less likely to undergo operative intervention, perhaps due to provider perception of surgery tolerance. While not statistically significant, there was a trend towards decreased post-discharge survival. The lack of significant results may be attributed to lower numbers. Additional long-term studies are needed to determine the true impact of sarcopenia on elderly trauma patients.