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Sarcopenia as a predictor of mortality in elderly blunt trauma patients: Comparing the masseter to the psoas using computed tomography.
J Trauma Acute Care Surg. 2017 01; 82(1):65-72.JT

Abstract

BACKGROUND

Sarcopenia, or age-related loss of muscle mass, is measurable by computed tomography (CT). In elderly trauma patients, increased mortality is associated with decreased psoas muscle cross-sectional area (P-Area) on abdominal CT. Fall is the leading cause of injury in the elderly, and head CT is more often obtained. Masseter muscle cross-sectional area (M-Area) is readily measured on head CT. Hypothesizing that M-Area is a satisfactory surrogate for P-Area, we compared the two as markers of sarcopenia and increased mortality in elderly trauma patients.

METHODS

All blunt-injured patients aged 65 years or older admitted to our trauma center during 2010 were included. Two-year postdischarge mortality was identified by matching records to county, state, and national death indices. Bilateral M-Area was measured on admission head CT at 2 cm below the zygomatic arch. Bilateral P-Area was measured on abdominal CT at the fourth vertebral body. Average M-Area and P-Area values were calculated for each patient. Cox proportional hazards models evaluated the relationship of M-Area and P-Area with mortality. Model predictive performance was calculated using concordance statistics.

RESULTS

Among 487 patients, 357 with M-Area and 226 with P-Area were identified. Females had smaller M-Area (3.43 cm vs 4.18 cm; p < 0.050) and P-Area (6.50 cm vs 10.9 cm; p < 0.050) than males. Masseter muscle cross-sectional area correlated with P-Area (rho, 0.38; p < 0.001). Adjusted Cox regression models revealed decreased survival associated with declining M-Area (hazard ratio, 0.76; 95% confidence interval, 0.60-0.96) and P-Area (hazard ratio, 0.68; 95% confidence interval, 0.46-1.00). Masseter muscle cross-sectional area and P-Area discriminated equally well in best-fit models.

CONCLUSIONS

In elderly trauma patients, M-Area is an equally valid and more readily available marker of sarcopenia and 2-year mortality than P-Area. Future study should validate M-Area as a metric to identify at-risk patients who may benefit from early intervention.

LEVEL OF EVIDENCE

Prognostic study, level III.

Authors+Show Affiliations

From the Trauma Service (J.D.W., R.Y.D., P.R.L., J.B.B., S.R.S., M.J.S., C.B.S., V.B.), Scripps Mercy Hospital, San Diego, California.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27820555

Citation

Wallace, James D., et al. "Sarcopenia as a Predictor of Mortality in Elderly Blunt Trauma Patients: Comparing the Masseter to the Psoas Using Computed Tomography." The Journal of Trauma and Acute Care Surgery, vol. 82, no. 1, 2017, pp. 65-72.
Wallace JD, Calvo RY, Lewis PR, et al. Sarcopenia as a predictor of mortality in elderly blunt trauma patients: Comparing the masseter to the psoas using computed tomography. J Trauma Acute Care Surg. 2017;82(1):65-72.
Wallace, J. D., Calvo, R. Y., Lewis, P. R., Brill, J. B., Shackford, S. R., Sise, M. J., Sise, C. B., & Bansal, V. (2017). Sarcopenia as a predictor of mortality in elderly blunt trauma patients: Comparing the masseter to the psoas using computed tomography. The Journal of Trauma and Acute Care Surgery, 82(1), 65-72. https://doi.org/10.1097/TA.0000000000001297
Wallace JD, et al. Sarcopenia as a Predictor of Mortality in Elderly Blunt Trauma Patients: Comparing the Masseter to the Psoas Using Computed Tomography. J Trauma Acute Care Surg. 2017;82(1):65-72. PubMed PMID: 27820555.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sarcopenia as a predictor of mortality in elderly blunt trauma patients: Comparing the masseter to the psoas using computed tomography. AU - Wallace,James D, AU - Calvo,Richard Y, AU - Lewis,Paul R, AU - Brill,Jason B, AU - Shackford,Steven R, AU - Sise,Michael J, AU - Sise,C Beth, AU - Bansal,Vishal, PY - 2016/11/8/pubmed PY - 2017/7/8/medline PY - 2016/11/8/entrez SP - 65 EP - 72 JF - The journal of trauma and acute care surgery JO - J Trauma Acute Care Surg VL - 82 IS - 1 N2 - BACKGROUND: Sarcopenia, or age-related loss of muscle mass, is measurable by computed tomography (CT). In elderly trauma patients, increased mortality is associated with decreased psoas muscle cross-sectional area (P-Area) on abdominal CT. Fall is the leading cause of injury in the elderly, and head CT is more often obtained. Masseter muscle cross-sectional area (M-Area) is readily measured on head CT. Hypothesizing that M-Area is a satisfactory surrogate for P-Area, we compared the two as markers of sarcopenia and increased mortality in elderly trauma patients. METHODS: All blunt-injured patients aged 65 years or older admitted to our trauma center during 2010 were included. Two-year postdischarge mortality was identified by matching records to county, state, and national death indices. Bilateral M-Area was measured on admission head CT at 2 cm below the zygomatic arch. Bilateral P-Area was measured on abdominal CT at the fourth vertebral body. Average M-Area and P-Area values were calculated for each patient. Cox proportional hazards models evaluated the relationship of M-Area and P-Area with mortality. Model predictive performance was calculated using concordance statistics. RESULTS: Among 487 patients, 357 with M-Area and 226 with P-Area were identified. Females had smaller M-Area (3.43 cm vs 4.18 cm; p < 0.050) and P-Area (6.50 cm vs 10.9 cm; p < 0.050) than males. Masseter muscle cross-sectional area correlated with P-Area (rho, 0.38; p < 0.001). Adjusted Cox regression models revealed decreased survival associated with declining M-Area (hazard ratio, 0.76; 95% confidence interval, 0.60-0.96) and P-Area (hazard ratio, 0.68; 95% confidence interval, 0.46-1.00). Masseter muscle cross-sectional area and P-Area discriminated equally well in best-fit models. CONCLUSIONS: In elderly trauma patients, M-Area is an equally valid and more readily available marker of sarcopenia and 2-year mortality than P-Area. Future study should validate M-Area as a metric to identify at-risk patients who may benefit from early intervention. LEVEL OF EVIDENCE: Prognostic study, level III. SN - 2163-0763 UR - https://www.unboundmedicine.com/medline/citation/27820555/Sarcopenia_as_a_predictor_of_mortality_in_elderly_blunt_trauma_patients:_Comparing_the_masseter_to_the_psoas_using_computed_tomography_ L2 - https://doi.org/10.1097/TA.0000000000001297 DB - PRIME DP - Unbound Medicine ER -