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J Acute Care Surg > Volume 11(3); 2021 > Article
Journal of Acute Care Surgery 2021;11(3):121-128.
DOI: https://doi.org/10.17479/jacs.2021.11.3.121    Published online November 23, 2021.
Visualizing Frailty: Exploring Radiographical Measures of Frailty in Trauma Patients
Omolola Fakunle1, Meet Patel1, Victoria G. Kravets1, Adam Singer2, Robert Hernandez-Irizarry3, Mara L. Schenker3 
1Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
2Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
3Division of Orthopedic Trauma, Emory University School of Medicine, Atlanta, GA, USA
Correspondence:  Omolola Fakunle,
Email: omololapfakunle@gmail.com
Received: 12 May 2021   • Revised: 26 August 2021   • Accepted: 26 August 2021
Abstract
Purpose
This study assessed the relationship of core muscle sarcopenia, myosteatosis, and L1 attenuation to the 5-factor modified frailty index (mFI-5), discharge disposition, and post-admission complications in orthopedic and general trauma patients. It was hypothesized that reduced sarcopenia, L1 attenuation, and increased myosteatosis is associated with higher mFI-5 scores (≥ 0.3), discharge into care, and increased post-admission complications.
Methods
This prospective cohort study was performed at a Level 1 trauma center. Patients were surveyed and metrics of the mFI-5 were used. Frail was categorized as a mFI-5 score ≥ 0.3. Recent abdominal computed tomography (CT) scans were used to extract radiographical information of total psoas cross-sectional area, psoas myosteatosis, and L1 vertebrae attenuation.
Results
There were 140 patients who consented to the study, of which 83 had available abdomen and pelvis CT scans. The mean age was 43.19 (± 17.36), and 65% were male (n = 52). When comparing the frail (16%, n = 13) and not frail (84%, n = 70) patients, there was a significant difference in mean psoas myosteatosis (p < 0.0001) and the attenuation of the L1 vertebrae (p < 0.001). On multivariate analysis when accounting for age, myosteatosis of the psoas muscles was predictive of an mFI-5 score ≥ 0.3.
Conclusion
The findings suggest that myosteatosis and L1 attenuation are associated with frailty indices (mFI-5) after traumatic injury. Future studies are needed to prospectively assess the validity of both radiographical and index-based markers of frailty in predicting post-traumatic complications, mortality, and hospital utilization.
Key Words: abdomen, frailty, injury, radiology, sarcopenia, trauma
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