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Functional Recovery in Elderly after Trauma: The Impact of Frailty
S152
Scientific Forum Abstracts
RESULTS: A total of 555 patients were enrolled, 62% of whom had WHR1. There were 212 (38%) patients who developed in-hospital complications, and mortality rate was 13.2%. Patients with WHR1 had higher in-hospital complications (50.3% vs 18.5%, p<0.001) and a higher mortality rate (16.9% vs 7.1%, p¼0.001) compared with the other group. On regression analysis, WHR1 was an independent predictor of in-hospital complications (odds ratio [OR] [95% CI] 4.39 [2.75-7.01]; p<0.001) and mortality (OR [95%CI] 3.38 [1.51-7.55]; p¼0.003). On correlation with BMI, WHR was weakly correlated with BMI (R2¼0.130, R¼0.361; p¼0.01). CONCLUSIONS: WHR, as measured by CT scan, reliably predicts risk for development of complications and mortality in trauma patients. It can be obtained easily and early in the hospital course, and therefore can identify high-risk patients. WHR should be considered a part of radiology reports for every trauma CT of the abdomen and pelvis. Computed Tomography-Measured Psoas Density Predicts Complications, Discharge Location, and Mortality in Trauma Patients Taehwan Yoo, MD, Wilson Lo, David C Evans, MD, FACS Ohio State University, Columbus, OH INTRODUCTION: Low muscle mass (sarcopenia) is linked to poor outcomes and function after surgery and trauma. Standardized methodology measuring sarcopenia has not been well defined. We hypothesized that CT findings of psoas density and size are related to morbidity and mortality after trauma. METHODS: We reviewed 152 patients ages 45 and older, who underwent blunt trauma evaluation in 2008 with abdominal CT venous contrast imaging at time of injury. Normalized total psoas muscle cross-sectional area (NTPA) and mean psoas Hounsfeld unit density (MPHU) were quantified with EasyViz software. Complications, 90-day mortality, and disposition were stratified based on MPHU, and NTPA. Chi-square, Fischer’s exact, Pearson Correlation, and Student’s t-test were used to determine the factors associated with our measures of sarcopenia. RESULTS: Patient characteristics included mean age of 58.9 years, 61.2% male, median Injury Severity Score (ISS) 9.0, complication rate 23%, and mortality 5.9%. The lowest interquartile range (IQR) of NTPA was linked to increased risk of inpatient death (relative risk [RR] 2.4, p ¼ 0.029), but failed to reach significance in other outcomes. The lowest IQR MPHU was associated with complication rate (RR 2.43, p ¼ 0.0012), dependent discharge (RR 2.0, p ¼ 0.017), and mortality (RR 2.98, p ¼ 0.003). MPHU moderately correlated with comorbidity-polypharmacy score (p ¼ -0.387, p < 0.0001). CONCLUSIONS: Psoas muscle density significantly predicts mortality, complication rate, and discharge location. Psoas density is a better predictor than psoas area. These simple measures may aid in identifying patients requiring aggressive nutritional and physical therapy regimens to improve prognosis, prevent recurrent traumatic injury, and aid in discharge planning.
J Am Coll Surg
Functional Recovery in Elderly after Trauma: The Impact of Frailty Ahmed Hassan, MD, Peter M Rhee, MD, MPH, FACS, FCCM, Kareem Ibraheem, MD, Tahereh O Jokar, MD, Andrew L Tang, MD, FACS, Terence O’Keeffe, MBChB, FACS, Narong Kulvatunyou, MD, FACS, Mindy J Fain, MD, Jane Mohler, MPH, Bellal Joseph, MD, FACS University of Arizona, Tucson, AZ INTRODUCTION: Frailty has been shown to adversely affect inhospital outcomes; however, its impact on functional status in elderly trauma patients remains unknown. The aim of this study was to assess the association between frailty and functional status in elderly trauma patients. METHODS: We performed a 2-year prospective study of elderly (age 65 years) trauma patients at our level I trauma center. Frailty was assessed using a 15-variable, trauma-specific frailty index (TSFI). Patients were stratified into non-frail, pre-frail, and frail. Functional status was assessed using functional independence measure (FIM) at admission and discharge. Delta FIM was defined as the difference between admission and discharge FIM. Multivariate linear regression analysis was performed. RESULTS: A total of 267 patients were enrolled; 61% were male. Mean age of the population was 75.4 9.85. 39.7% were frail, and 37.5% were pre-frail. Mean TSFI was 0.24 0.16 and mean delta FIM was -1.06 1.68. Frail patients had higher decline in delta FIM compared with pre-frail (p¼0.02) and non-frail (p¼0.04) patients (Table). On regression analysis for factors associated with delta FIM, frailty was negatively associated with delta FIM (beta [95% CI], -0.208 [-1.320 e -1.99], p¼0.008). Age, sex, injury mechanism, injury severity, and insurance status were not associated with delta FIM. Table. Functional Independence Measure (FIM) FIM Non-frail Pre-frail Frail Admission FIM, mean SD 11.98 0.14 11.96 0.18 11.81 0.52 Discharge FIM, mean SD 11.20 0.80 11.14 1.51 10.32 2.14 Delta FIM, mean SD -0.78 0.815 -0.82 1.51 -1.48 2.1
p Value 0.004 0.002 0.013
CONCLUSIONS: Frail patients were less likely to recover to their baseline functional status compared with non-frail patients. Early focused intervention in frail elderly patients is warranted to improve functional status in this population. Geriatric Pelvic Trauma: An Underestimated Injury Pattern in a Vulnerable Population Eleanor A Fallon, MD, Aaron L Harman, MD, Hector Nunez, Daithi J Heffernan, MD, Sean F Monaghan, MD, Charles A Adams, Jr, MD, FACS, FCCM, William G Cioffi, Jr, MD, FACS, Andrew H Stephen, MD, FACS Brown University/Rhode Island Hospital, Providence, RI INTRODUCTION: Factors predictive of poor outcomes in young trauma patients, including mechanism and pattern of injury, may not be as predictive in older trauma patients. We hypothesized that minor mechanisms lead to just as significant negative
Scientific Forum Abstracts
RESULTS: A total of 555 patients were enrolled, 62% of whom had WHR1. There were 212 (38%) patients who developed in-hospital complications, and mortality rate was 13.2%. Patients with WHR1 had higher in-hospital complications (50.3% vs 18.5%, p<0.001) and a higher mortality rate (16.9% vs 7.1%, p¼0.001) compared with the other group. On regression analysis, WHR1 was an independent predictor of in-hospital complications (odds ratio [OR] [95% CI] 4.39 [2.75-7.01]; p<0.001) and mortality (OR [95%CI] 3.38 [1.51-7.55]; p¼0.003). On correlation with BMI, WHR was weakly correlated with BMI (R2¼0.130, R¼0.361; p¼0.01). CONCLUSIONS: WHR, as measured by CT scan, reliably predicts risk for development of complications and mortality in trauma patients. It can be obtained easily and early in the hospital course, and therefore can identify high-risk patients. WHR should be considered a part of radiology reports for every trauma CT of the abdomen and pelvis. Computed Tomography-Measured Psoas Density Predicts Complications, Discharge Location, and Mortality in Trauma Patients Taehwan Yoo, MD, Wilson Lo, David C Evans, MD, FACS Ohio State University, Columbus, OH INTRODUCTION: Low muscle mass (sarcopenia) is linked to poor outcomes and function after surgery and trauma. Standardized methodology measuring sarcopenia has not been well defined. We hypothesized that CT findings of psoas density and size are related to morbidity and mortality after trauma. METHODS: We reviewed 152 patients ages 45 and older, who underwent blunt trauma evaluation in 2008 with abdominal CT venous contrast imaging at time of injury. Normalized total psoas muscle cross-sectional area (NTPA) and mean psoas Hounsfeld unit density (MPHU) were quantified with EasyViz software. Complications, 90-day mortality, and disposition were stratified based on MPHU, and NTPA. Chi-square, Fischer’s exact, Pearson Correlation, and Student’s t-test were used to determine the factors associated with our measures of sarcopenia. RESULTS: Patient characteristics included mean age of 58.9 years, 61.2% male, median Injury Severity Score (ISS) 9.0, complication rate 23%, and mortality 5.9%. The lowest interquartile range (IQR) of NTPA was linked to increased risk of inpatient death (relative risk [RR] 2.4, p ¼ 0.029), but failed to reach significance in other outcomes. The lowest IQR MPHU was associated with complication rate (RR 2.43, p ¼ 0.0012), dependent discharge (RR 2.0, p ¼ 0.017), and mortality (RR 2.98, p ¼ 0.003). MPHU moderately correlated with comorbidity-polypharmacy score (p ¼ -0.387, p < 0.0001). CONCLUSIONS: Psoas muscle density significantly predicts mortality, complication rate, and discharge location. Psoas density is a better predictor than psoas area. These simple measures may aid in identifying patients requiring aggressive nutritional and physical therapy regimens to improve prognosis, prevent recurrent traumatic injury, and aid in discharge planning.
J Am Coll Surg
Functional Recovery in Elderly after Trauma: The Impact of Frailty Ahmed Hassan, MD, Peter M Rhee, MD, MPH, FACS, FCCM, Kareem Ibraheem, MD, Tahereh O Jokar, MD, Andrew L Tang, MD, FACS, Terence O’Keeffe, MBChB, FACS, Narong Kulvatunyou, MD, FACS, Mindy J Fain, MD, Jane Mohler, MPH, Bellal Joseph, MD, FACS University of Arizona, Tucson, AZ INTRODUCTION: Frailty has been shown to adversely affect inhospital outcomes; however, its impact on functional status in elderly trauma patients remains unknown. The aim of this study was to assess the association between frailty and functional status in elderly trauma patients. METHODS: We performed a 2-year prospective study of elderly (age 65 years) trauma patients at our level I trauma center. Frailty was assessed using a 15-variable, trauma-specific frailty index (TSFI). Patients were stratified into non-frail, pre-frail, and frail. Functional status was assessed using functional independence measure (FIM) at admission and discharge. Delta FIM was defined as the difference between admission and discharge FIM. Multivariate linear regression analysis was performed. RESULTS: A total of 267 patients were enrolled; 61% were male. Mean age of the population was 75.4 9.85. 39.7% were frail, and 37.5% were pre-frail. Mean TSFI was 0.24 0.16 and mean delta FIM was -1.06 1.68. Frail patients had higher decline in delta FIM compared with pre-frail (p¼0.02) and non-frail (p¼0.04) patients (Table). On regression analysis for factors associated with delta FIM, frailty was negatively associated with delta FIM (beta [95% CI], -0.208 [-1.320 e -1.99], p¼0.008). Age, sex, injury mechanism, injury severity, and insurance status were not associated with delta FIM. Table. Functional Independence Measure (FIM) FIM Non-frail Pre-frail Frail Admission FIM, mean SD 11.98 0.14 11.96 0.18 11.81 0.52 Discharge FIM, mean SD 11.20 0.80 11.14 1.51 10.32 2.14 Delta FIM, mean SD -0.78 0.815 -0.82 1.51 -1.48 2.1
p Value 0.004 0.002 0.013
CONCLUSIONS: Frail patients were less likely to recover to their baseline functional status compared with non-frail patients. Early focused intervention in frail elderly patients is warranted to improve functional status in this population. Geriatric Pelvic Trauma: An Underestimated Injury Pattern in a Vulnerable Population Eleanor A Fallon, MD, Aaron L Harman, MD, Hector Nunez, Daithi J Heffernan, MD, Sean F Monaghan, MD, Charles A Adams, Jr, MD, FACS, FCCM, William G Cioffi, Jr, MD, FACS, Andrew H Stephen, MD, FACS Brown University/Rhode Island Hospital, Providence, RI INTRODUCTION: Factors predictive of poor outcomes in young trauma patients, including mechanism and pattern of injury, may not be as predictive in older trauma patients. We hypothesized that minor mechanisms lead to just as significant negative