{"title":"咬肌面积减少预测老年人轻度创伤性脑损伤后6个月的预后","authors":"Liang Wu, Yunfei Li, Meng Sun, Nanyu Yao, Zhaofeng Zhang, Weiming Liu","doi":"10.1002/agm2.70040","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>Mild traumatic brain injury (mTBI) in older patients is a common condition in neurosurgery, often linked to poor long-term outcomes, especially when accompanied by frailty. Sarcopenia contributes to this frailty and can be assessed through transverse imaging methods. This study aimed to assess the prognostic value of the masseter muscle cross-sectional area (MCSA) as determined from admission CT head scans in older patients with mTBI.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective study identified older patients with mTBI who were admitted to our hospital from April 2013 to December 2022. The Glasgow Outcome Scale Extended (GOSE) was utilized to assess neurological outcomes at 6 months follow-up, which were divided into complete recovery (GOSE = 8) and incomplete recovery (GOSE ≤ 7). We measured the average MCSA using admission CT scans and evaluated the consistency of these measurements. Multivariable logistic regression was conducted to evaluate the association between reduced MCSA and 6-month clinical outcomes in older mTBI patients while adjusting for age, gender, and comorbidity.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The study involved 227 patients, 135 (59.5%) males and 92 (40.5%) females, with a mean age of 74.1 years. 92 (40.5%) had an adverse clinical outcome by the end of follow-up. The intra- and inter-observer reliability of the MCSA measurements was good to excellent (ICCs = 0.955–0.972 and 0.856–0.892). MCSA decreased with age (Pearson's <i>r</i> = −0.290, <i>p</i> < 0.001). Males had higher MCSA than females (<i>p</i> < 0.001). The optimal MCSA cutoff values for predicting 6-month clinical outcomes were 358.75 mm<sup>2</sup> for male and 263.25 mm<sup>2</sup> for female patients. Reduced MCSA was associated with 6-month clinical outcomes in univariate and multivariate logistic analyses (OR = 0.131, 95% CI: 0.063–0.273; <i>p</i> < 0.001). The MCSA was linearly associated with incomplete recovery (<i>p</i> < 0.001, P for nonlinear = 0.127).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>MCSA measurements from initial scans were reliable, providing prognostic information that supplemented existing predictors of poor outcomes in older mTBI patients.</p>\n </section>\n </div>","PeriodicalId":32862,"journal":{"name":"Aging Medicine","volume":"8 4","pages":"294-302"},"PeriodicalIF":2.5000,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/agm2.70040","citationCount":"0","resultStr":"{\"title\":\"Reduced Masseter Muscle Area Predicts the 6-Month Outcome After Mild Traumatic Brain Injury in Older Adults\",\"authors\":\"Liang Wu, Yunfei Li, Meng Sun, Nanyu Yao, Zhaofeng Zhang, Weiming Liu\",\"doi\":\"10.1002/agm2.70040\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>Mild traumatic brain injury (mTBI) in older patients is a common condition in neurosurgery, often linked to poor long-term outcomes, especially when accompanied by frailty. Sarcopenia contributes to this frailty and can be assessed through transverse imaging methods. This study aimed to assess the prognostic value of the masseter muscle cross-sectional area (MCSA) as determined from admission CT head scans in older patients with mTBI.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This retrospective study identified older patients with mTBI who were admitted to our hospital from April 2013 to December 2022. The Glasgow Outcome Scale Extended (GOSE) was utilized to assess neurological outcomes at 6 months follow-up, which were divided into complete recovery (GOSE = 8) and incomplete recovery (GOSE ≤ 7). We measured the average MCSA using admission CT scans and evaluated the consistency of these measurements. Multivariable logistic regression was conducted to evaluate the association between reduced MCSA and 6-month clinical outcomes in older mTBI patients while adjusting for age, gender, and comorbidity.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>The study involved 227 patients, 135 (59.5%) males and 92 (40.5%) females, with a mean age of 74.1 years. 92 (40.5%) had an adverse clinical outcome by the end of follow-up. The intra- and inter-observer reliability of the MCSA measurements was good to excellent (ICCs = 0.955–0.972 and 0.856–0.892). MCSA decreased with age (Pearson's <i>r</i> = −0.290, <i>p</i> < 0.001). Males had higher MCSA than females (<i>p</i> < 0.001). The optimal MCSA cutoff values for predicting 6-month clinical outcomes were 358.75 mm<sup>2</sup> for male and 263.25 mm<sup>2</sup> for female patients. Reduced MCSA was associated with 6-month clinical outcomes in univariate and multivariate logistic analyses (OR = 0.131, 95% CI: 0.063–0.273; <i>p</i> < 0.001). 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引用次数: 0
摘要
老年患者的轻度创伤性脑损伤（mTBI）是神经外科的常见情况，通常与不良的长期预后有关，特别是当伴有虚弱时。骨骼肌减少症是造成这种脆弱的原因之一，可以通过横向成像方法进行评估。本研究旨在评估老年mTBI患者入院时CT头部扫描确定的咬肌横截面积（MCSA）的预后价值。方法回顾性研究2013年4月至2022年12月我院收治的老年mTBI患者。随访6个月时采用格拉斯哥预后扩展量表（GOSE）评估神经系统预后，分为完全恢复（GOSE = 8）和不完全恢复（GOSE≤7）。我们使用入院CT扫描测量平均MCSA，并评估这些测量结果的一致性。在调整年龄、性别和合并症的情况下，采用多变量logistic回归来评估老年mTBI患者MCSA降低与6个月临床结果之间的关系。结果共纳入227例患者，男性135例（59.5%），女性92例（40.5%），平均年龄74.1岁。随访结束时，92例（40.5%）出现不良临床结果。MCSA测量值的观察者内部和观察者之间的信度从良好到优异（ICCs = 0.955-0.972和0.856-0.892）。MCSA随着年龄的增长而下降（Pearson’s r = - 0.290, p < 0.001）。男性的MCSA高于女性（p < 0.001）。预测6个月临床结果的最佳MCSA临界值为男性患者358.75 mm2，女性患者263.25 mm2。单因素和多因素logistic分析显示，MCSA降低与6个月的临床结果相关（OR = 0.131, 95% CI: 0.063-0.273; p < 0.001）。MCSA与不完全恢复呈线性相关（p < 0.001，非线性p = 0.127）。结论：初始扫描的MCSA测量值是可靠的，提供的预后信息补充了老年mTBI患者预后不良的现有预测因子。
Reduced Masseter Muscle Area Predicts the 6-Month Outcome After Mild Traumatic Brain Injury in Older Adults
Objectives
Mild traumatic brain injury (mTBI) in older patients is a common condition in neurosurgery, often linked to poor long-term outcomes, especially when accompanied by frailty. Sarcopenia contributes to this frailty and can be assessed through transverse imaging methods. This study aimed to assess the prognostic value of the masseter muscle cross-sectional area (MCSA) as determined from admission CT head scans in older patients with mTBI.
Methods
This retrospective study identified older patients with mTBI who were admitted to our hospital from April 2013 to December 2022. The Glasgow Outcome Scale Extended (GOSE) was utilized to assess neurological outcomes at 6 months follow-up, which were divided into complete recovery (GOSE = 8) and incomplete recovery (GOSE ≤ 7). We measured the average MCSA using admission CT scans and evaluated the consistency of these measurements. Multivariable logistic regression was conducted to evaluate the association between reduced MCSA and 6-month clinical outcomes in older mTBI patients while adjusting for age, gender, and comorbidity.
Results
The study involved 227 patients, 135 (59.5%) males and 92 (40.5%) females, with a mean age of 74.1 years. 92 (40.5%) had an adverse clinical outcome by the end of follow-up. The intra- and inter-observer reliability of the MCSA measurements was good to excellent (ICCs = 0.955–0.972 and 0.856–0.892). MCSA decreased with age (Pearson's r = −0.290, p < 0.001). Males had higher MCSA than females (p < 0.001). The optimal MCSA cutoff values for predicting 6-month clinical outcomes were 358.75 mm2 for male and 263.25 mm2 for female patients. Reduced MCSA was associated with 6-month clinical outcomes in univariate and multivariate logistic analyses (OR = 0.131, 95% CI: 0.063–0.273; p < 0.001). The MCSA was linearly associated with incomplete recovery (p < 0.001, P for nonlinear = 0.127).
Conclusions
MCSA measurements from initial scans were reliable, providing prognostic information that supplemented existing predictors of poor outcomes in older mTBI patients.
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