Lean psoas area does not correlate with clinical outcomes in moderately to severely injured older people

ObjectiveFrailty has been associated with worse outcomes in older trauma patients. Specifically, the utility of lean cross-sectional psoas muscle area (LPA) was examined as a potentially simple objective measure of frailty. MethodsFive hundred and fifty-four patients over the age of 65 were admitted with trauma between 2011 and 2014. Two hundred and twenty-five of these had adequate computed tomography imaging available for analysis. Cross-sectional area of the psoas muscle at the inferior endplate of L4 was quantified. ResultsMultivariate regression analysis showed no significant correlation between LPA and outcomes of mortality (P = 0.82) or inpatient complications (P = 0.22). Injury Severity Score (ISS) had a strong association with both mortality (odds ratio (OR) 9.5; 95% confidence interval (CI) 2.9-30.9) and inpatient complications (OR 9.9; 95% CI 3.5-27.7). Age also had an association with mortality (OR 1.09; 95% CI 1.03-1.16) and inpatient complications (OR 1.06; 95% CI 1.01-1.12). ConclusionLean psoas area was not an independent predictor of mortality or complications in a cohort of injured older patients. Policy Impact: This article demonstrates that the outcomes of acute geriatric trauma are best predicted by the severity of the trauma. Management as guided by the clinical scenario is appropriate, and no change to policy is suggested from the outcome of this article. Practice Impact: This retrospective cohort study reiterates the need for further research to develop an objective measure of frailty in our older patients to assist with a more clinically oriented decision-making process for patient care.