Paraspinous Sarcopenia predictor of prognosis in Geriatric trauma patients: Study

A recent study finds that the surrogate measurement of frailty of Paraspinous Sarcopenia at T12 level guides in long term prognostication in geriatric trauma patients. The study was Published in 'JAMA Surgery' 2020.

The paraspinous muscle group can be readily measured on abdominal and chest CT scans during trauma evaluation. Sarcopenia of these muscles can be a good surrogate for physical frailty in geriatric trauma patients. Dr. Kaplan from Virginia Mason Medical Centre and et al conducted a study with a hypothesis that paraspinous sarcopenia at the T12 level correlates with previously established thresholds at the lumbar level and is associated with poor long-term outcomes in older trauma patients.

The study was conducted by collecting data from January 2011 to December 2014 of trauma patients who are 65 years and older at a single level 1 trauma centre. Chest and/or abdominal CT imaging obtained were used to determine cross-sectional area of paraspinous and abdominal muscles at the T12 and L3 levels. Skeletal muscle index (SMI) was calculated as cross sectional area divided by height squared (cm2 /m2). Established L3 SMI thresholds were correlated with paraspinous T12 SMI to identify optimal sex-specific sarcopenia thresholds.

The key findings of the study were:

• Out of the 450 patients, 316 (70.2%) had comparable L3 imaging available for T12 threshold development.

• The median age was 75 years and out of these 192 patients (42.7%) were female.

• The correlation between T12 SMI and L3 SMI was strong (ρ = 0.63; P < .001).

• The T12 SMI thresholds with the best model performance were 9.01cm2 /m2 for women and 10.66cm2 /m2 for men.

• Patients were dichotomized into sarcopenic and non sarcopenic groups using these T12 thresholds.

• Short-term outcomes did not differ between sarcopenic and non sarcopenic groups.

• One-year mortality was significantly higher in patients with sarcopenia (34 [16%] vs 7 [3%]; P < .001; hazard ratio, 3.3; 95% CI, 1.3–8.5; P = .01).

Thus, the authors concluded that that paraspinous sarcopenia at the T12 level is a good, widely accessible, surrogate measurement of frailty that may help guide long-term prognostication in geriatric trauma patients following prospective confirmation of utility.