Background: Sarcopenia is a key physical component in the aetiology of frailty. In older trauma patients admitted to critical care, sarcopenic defined-frailty is associated with adverse outcomes, including poor function at discharge.This study aimed to identify pre-injury sarcopenia in trauma patients admitted to critical care and investigate factors associated with discharge.
Methods: We performed a retrospective analysis of trauma patients admitted over 18 months. Psoas muscle density (PMD) was measured at L4 vertebra from admission computerised tomography (CT) abdomen/pelvis. Sarcopenia was defined as the PMD calculated using Hounsfield unit average calculation within the lowest quartile for sex. Discharge destination was dichotomised into independent and dependent. Multivariable logistic regression was used to determine factors associated with discharge destination.
Results: 97 patients were included. Patients were predominantly male (73%) with a median age of 52 (32-72) and the majority were severely injured (72%). Sarcopenia was identified in a quarter of the cohort on admission to critical care (n=49). Only a third of sarcopenic patients were discharged to home, compared to a half of non-sarcopenic patients (p=0.03). Sarcopenia (OR 0.30; 95% CI 0.17-0.81, p=0.01), blunt injury (OR 0.22; 95% CI 0.06-0.87, p=0.03), age (OR 0.97; 95% CI 0.95-0.99, p=0.01) and Multiple Organ Dysfunction Syndrome (MODs) (OR 0.24; 95% CI 0.12-0.57, p=0.01) were associated with a decreased rate of independent discharge.
Conclusion: For trauma critical care patients, sarcopenia on CT was associated with dependent discharge and therefore is unfavourable. Defining sarcopenia early in a trauma patients admission may identify those at risk of poor outcomes.