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Original Investigation
February 15, 2017

Association of Radiologic Indicators of Frailty With 1-Year Mortality in Older Trauma PatientsOpportunistic Screening for Sarcopenia and Osteopenia

Author Affiliations
  • 1Section of General, Thoracic, and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
  • 2Division of Gerontology and Geriatric Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle
  • 3Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, Harborview Medical Center, University of Washington, Seattle
  • 4Department of Radiology, Harborview Medical Center, University of Washington, Seattle
  • 5Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle
  • 6Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle
  • 7Division of Emergency Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle
JAMA Surg. 2017;152(2):e164604. doi:10.1001/jamasurg.2016.4604
Key Points

Question  Is opportunistic assessment of sarcopenia and osteopenia as radiologic indicators of frailty in the trauma population predictive of 1-year mortality?

Findings  In this cohort study of 450 adults 65 years and older, sarcopenia, osteopenia, or both were present in more than half the cohort and were strongly associated with 1-year mortality, even after adjustment for other factors.

Meaning  Screening for radiologic indicators of frailty may improve prognostic ability, which may help early risk stratification and the design of tailored interventions for this subset of older trauma patients.

Abstract

Importance  Assessment of physical frailty in older trauma patients admitted to the intensive care unit is often not feasible using traditional frailty assessment instruments. The use of opportunistic computed tomography (CT) scans to assess sarcopenia and osteopenia as indicators of underlying frailty may provide complementary prognostic information on long-term outcomes.

Objective  To determine whether sarcopenia and/or osteopenia are associated with 1-year mortality in an older trauma patient population.

Design, Setting, and Participants  A retrospective cohort constructed from a state trauma registry was linked to the statewide death registry and Comprehensive Hospital Abstract Reporting System for readmission data analyses. Admission abdominopelvic CT scans from patients 65 years and older admitted to the intensive care unit of a single level I trauma center between January 2011 and May 2014 were analyzed to identify patients with sarcopenia and/or osteopenia. Patients with a head Injury Severity Score of 3 or greater, an out-of-state address, or inadequate CT imaging or who died within 24 hours of admission were excluded.

Exposures  Sarcopenia and/or osteopenia, assessed via total cross-sectional muscle area and bone density at the L3 vertebral level, compared with a group with no sarcopenia or osteopenia.

Main Outcomes and Measures  One-year all-cause mortality. Secondary outcomes included 30-day all-cause mortality, 30-day readmission, hospital length of stay, hospital cost, and discharge disposition.

Results  Of the 450 patients included in the study, 269 (59.8%) were male and 394 (87.6%) were white. The cohort was split into 4 groups: 74 were retrospectively diagnosed with both sarcopenia and osteopenia, 167 with sarcopenia only, 48 with osteopenia only, and 161 with no radiologic indicators. Among the 408 who survived to discharge, sarcopenia and osteopenia were associated with higher risks of 1-year mortality alone and in combination. After adjustment, the hazard ratio was 9.4 (95% CI, 1.2-75.4; P = .03) for sarcopenia and osteopenia, 10.3 (95% CI, 1.3-78.8; P = .03) for sarcopenia, and 11.9 (95% CI, 1.3-107.4; P = .03) for osteopenia.

Conclusions and Relevance  More than half of older trauma patients in this study had sarcopenia, osteopenia, or both. Each factor was independently associated with increased 1-year mortality. Given the prevalent use of abdominopelvic CT in trauma centers, opportunistic screening for radiologic indicators of frailty provides an additional tool for early identification of older trauma patients at high risk for poor outcomes, with the potential for targeted interventions.

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