Radiographic sarcopenic obesity measurements in elderly trauma patients do not predict adverse discharge disposition over injury severity score

Abstract

There is a need for a predictive tool for adverse discharge disposition in the injured elderly patient population. However, many measurements of frailty are not practical and radiographic measurements of muscle and adipose tissue have yet to be correlated with adverse discharge disposition in this population. A retrospective review of a prospectively gathered trauma database at a level one trauma center was performed, studying all adult trauma patients aged 55 years or older with an inpatient stay of greater than 2 days. Patients with a non-survivable head trauma (head Abbreviated Injury Score of 6) or serious central nervous system injury, history of cirrhosis or solid organ transplantation, those actively being treated with immunosuppressive medications, and those without an abdominal computerized tomography (CT) scan within the first 48 h of admission were excluded. Sarcopenia, sarcopenic obesity (SO), and five-item frailty index (5-iFI) score were obtained and analyzed against adverse discharge disposition. The study evaluated 444 patients, of which 48.9% were male with a median age of 78 years (range 55–99 years). All patients sustained blunt trauma, shock index was positive in 13.7%, and median ISS was 10 (range 1–43). SO was not independently predictive of adverse discharge disposition. Additionally, neither sarcopenia nor 5-iFI scores were found to be independently predictive. Lower ISS and age were found to be protective against adverse discharge disposition. CT-based measurements of muscle and adipose tissue may not add value over traditional injury scores in older trauma patients.