CT can indicate mortality risk in elderly with trauma

Last Updated: 2017-01-05

By David Douglas

NEW YORK (Reuters Health) - Opportunistic CT screening for osteopenia and sarcopenia in older adults with traumatic injury can provide insight into frailty and one-year mortality, according to Seattle-based researchers.

This approach, Dr. Stephen J. Kaplan told Reuters Health by email, "is a potentially powerful tool in the prognostic toolbox. The next steps in operationalizing our findings include simplifying the screening process, investigating associations with additional long-term outcomes such as quality of life, and designing patient-tailored interventions to mitigate the effect of frailty."

For their study, online December 28 in JAMA Surgery, Dr. Kaplan of Virginia Mason Medical Center and colleagues analyzed data from a Washington State trauma registry on patients aged 65 years or more; they included 450 patients with abdominopelvic CT imaging obtained within 48 hours of admission.

In all, 74 were retrospectively diagnosed with both sarcopenia and osteopenia, 167 with sarcopenia only, 48 with osteopenia only, and 161 had no radiologic indicators.

Of the 404 patients who survived until discharge, both conditions were associated with increased one-year mortality. After adjustment, the hazard ratio with sarcopenia and osteopenia combined was 9.4 (p=0.03). For sarcopenia alone, it was 10.3 (p=0.03) and for osteopenia alone, 11.9 (p=0.03).

Using such screening, continued Dr. Kaplan, "The overarching goals are to optimize the care we provide to older adults with traumatic injuries, and ultimately to improve long-term survival and quality of life in this vulnerable population."

Dr. Erika L. Rangel, author of an accompanying editorial, told Reuters Health by email that the researchers "have given us important information on the relationship between long-term mortality, sarcopenia, and osteopenia in a particularly vulnerable group, the elderly trauma victim."

Dr. Rangel of Brigham and Women's Hospital, Boston, added that the study "highlights questions that remain in our effort to improve geriatric trauma care. Future work must examine how these radiologic markers impact long-term functional status after injury in this group, particularly as they may prioritize quality of life over longevity."

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JAMA Surg 2016.