scholarly journals 4441 Comparing 3 methods of assessment of psoas area as a proxy for sarcopenia in predicting short-term outcomes in trauma patients 55 years and older

2020 ◽  
Vol 4 (s1) ◽  
pp. 126-126
Author(s):  
Anna Meader ◽  
Mihaela Stefan ◽  
David E. Clark ◽  
Christine W. Lary ◽  
Paul K. J. Han
Keyword(s):  
Population Distribution ◽  
Medical Center ◽  
Psoas Muscle ◽  
Predictive Ability ◽  
R Package ◽  
Morbidity And Mortality ◽  
Trauma Patients ◽  
Maine Medical ◽  
Hospital Morbidity ◽  
High Level

OBJECTIVES/GOALS: Specific Aim 1 To examine sex distribution of psoas cross sectional area (CSA) on CT imaging in a cohort of trauma patients age 55 and older. We will use three methods of assessing psoas CSA: psoas CSA averaged between left and right, average psoas CSA adjusted for height, and average psoas CSA adjusted for body surface area (psoas index). Specific Aim 2 Use multivariable logistic regression prediction modeling to compare the 3 methods of CT psoas muscle measurement widely used in the literature in their ability to predict a composite of in-hospital morbidity and mortality in trauma patients ages 55 and older. METHODS/STUDY POPULATION: The Maine Medical Center Trauma Registry is maintained by the Trauma Surgery Service at Maine Medical Center in Portland, Maine, the only Level-1 trauma center in the state. After receiving approval from the Institutional Review Board of Maine Medical Center for this retrospective cohort study, we queried the Maine Medical Center Trauma Registry for all adults 55 years and older who underwent evaluation by the Trauma Service between January 1, 2015 and January 1, 2019. In the case of multiple admissions within the study time period, only a patient’s index admission was used. MaineHealth IMPACS imaging software was used to measure bilateral psoas CSA on each patient CT. The Maine Medical Center electronic medical record was queried for additional clinical information including the ICD codes associated with each patient encounter. Data analysis was performed using R statistical software (R project, Vienna, Austria). Data is reported as median + IQR for CSA measurements. The agreement between the three methods of quantifying psoas CSA was evaluated using Pearson correlation (R package “stats”). Inter-rater reliability of psoas muscle measurements was evaluated using intra-class correlation (R package “irr”). Prediction models for the composite outcome of in-hospital morbidity and mortality were constructed using multivariable logistic regression. Bootstrapping was used for internal validation and shrinkage to avoid overfitting. Models including psoas CSA were compared to a baseline model without psoas CSA to evaluated incremental added predictive ability. RESULTS/ANTICIPATED RESULTS: This cohort provides a basis for examining the population distribution of psoas CSA in adults 55 years and older. IN addition to a high level of agreement between the three methods of measuring psoas CSA (Spearman coefficient > 0.9), there was also high level of inter rater reliability in psoas muscle assessment (intraclass correlation 0.9). We anticipate that psoas CSA adjusted for body surface area will add the most incremental predictive ability to a model predicting in-hospital morbidity and mortality. DISCUSSION/SIGNIFICANCE OF IMPACT: Given the heterogeneity of health status amongst elderly trauma patients, a major challenge lies in the rapid objective identification of those elderly trauma patients who are frail. Due to the limitations in current frailty measures, there has been a surge of interest in surrogate markers of frailty, such as muscle mass, as predictive factors of poor outcomes after trauma.Several studies have found that sarcopenia is associated with post injury morbidity and mortality. Estimates of the prevalence of sarcopenia among trauma patients vary across studies due to differences in definition and sample characteristics. In order to appropriately categorize patients as sarcopenic, the population distribution of psoas CSA on CT must be established. The psoas measurement that best correlates with outcomes has yet to be determined, and it is unclear which measurement should be implemented in usual practice. Our main objective is to improve the outcomes of sarcopenic patients hospitalized with trauma by implementing in the future patient-centered interventions which will account for sarcopenia.

Sarcopenia prior to and following chemotherapy to predict morbidity in patients undergoing post-chemotherapy retroperitoneal lymphadenectomy (PC-RPLND).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 381-381
Author(s):  
Fady Baky ◽  
Solomon L. Woldu ◽  
Vitaly Margulis ◽  
Aditya Bagrodia
Keyword(s):  
Medical Center ◽  
Germ Cell Tumors ◽  
Psoas Muscle ◽  
Safety Net ◽  
Morbidity And Mortality ◽  
Hospital Length Of Stay ◽  
Cross Sectional ◽  
Retroperitoneal Lymphadenectomy ◽  
Lumbar Vertebral Body ◽  
Safety Net Hospital

381 Background: Patients undergoing post-chemotherapy retroperitoneal lymphadenectomy (PC-RPLND) are subject to variable but substantial risks. Unlike those patients undergoing other extirpative GU surgeries, patients undergoing PC-RPLND are usually younger and possess fewer co-morbidities. Despite this, the burden of metastatic disease and the effects of pre-operative chemotherapy may leave patients poorly conditioned prior to undergoing surgery. Sarcopenia has previously been demonstrated to predict adverse clinical outcomes in a variety of abdominal surgeries. We hypothesized that sarcopenia would be similarly predictive of morbidity and mortality in patients undergoing PC-RPLND. Methods: The records of all patients undergoing post-chemotherapy retroperitoneal lymphadenectomy for the treatment of metastatic germ cell tumors at both a public safety net hospital and an academic tertiary medical center were reviewed. Sarcopenia was assessed by measuring cross sectional area of the psoas muscle at the middle of the third lumbar vertebral body on pre-chemotherapy and preoperative computerized tomography. Psoas Muscle Index (PMI) was calculated by adjusting total psoas area for patient height (cm2/m2). Univariate and multivariate analysis was performed to assess the predictive value of sarcopenia for morbidity and mortality following PC-RPLND. Results: 90 patients underwent PC-RPLND from the year 2006-2019, of whom 81 patients had both pre-chemo and preoperative cross sectional imaging available. Prior to chemotherapy the mean PMI for this cohort was 7.32 cm2/m2, and this did not significantly change following chemotherapy mean PMI = 7.06 cm2/m2 (p = 0.44). Lower PMI both prior to (p = 0.05) and following chemotherapy (p = 0.03) were predictive of a higher risk of post-operative complication. There was a trend towards longer hospital length of stay in patients with more significant sarcopenia, however this was not clinically significant (p = 0.09). Conclusions: Sarcopenia was predictive of morbidity in patients undergoing PC-RPLND. Although sarcopenia did worsen following chemotherapy this was not statistically significant. Further assessment of sarcopenia and pre-operative nutritional status in this population may provide opportunities to reduce morbidity following PC-RPLND.

scholarly journals 3251 Psoas muscle caliber as a predictor of negative outcomes in elderly trauma patients

2019 ◽  
Vol 3 (s1) ◽  
pp. 153-153
Author(s):  
Anna Meader ◽  
Damien Carter ◽  
David Clark ◽  
Mihaela Stefan
Keyword(s):  
Readmission Rate ◽  
Medical Center ◽  
Objective Measure ◽  
Psoas Muscle ◽  
Ct Imaging ◽  
Rib Fractures ◽  
Muscle Size ◽  
Trauma Patients ◽  
Targeted Interventions ◽  
Increased Risk

OBJECTIVES/SPECIFIC AIMS: Aim 1: To evaluate whether psoas muscle size on CT imaging can be used as univariate predictor for increased risk of morbidity and mortality in trauma patients 65 years or older with rib fractures. Primary outcomes will be 30 day mortality. Secondary outcomes will include length of stay, 30 day readmission rate, need for operative/procedural intervention, ICU days, ventilator days, discharge to rehabilitation. Aim 2: An eventual goal of the project will be to use the results of the single variable psoas size study to inform the development of a predictive model for readmission rate in this population based on clinical variables present at admission. METHODS/STUDY POPULATION: This retrospective cohort study will utilize the Maine Trauma Registry to conduct a database review for all persons 65 years of age and older admitted to Maine Medical Center between January 1, 2015 and December 31, 2017 with rib fracture as diagnosed by CT imaging. Psoas caliber will be measured on admission CT. Patient outcomes will be assessed via EMR review. RESULTS/ANTICIPATED RESULTS: Anticipate finding a relationship between decreased psoas caliber and increase in 30 day mortality and post trauma complications. DISCUSSION/SIGNIFICANCE OF IMPACT: If a relationship is demonstrated between decreased psoas caliber and poor outcomes in elderly patients with rib fractures, this early indicator could be used to identify those patients at most risk, for whom targeted interventions may make the greatest difference. Knowing a measure of frailty could also help guide goals of care discussions, because it would allow clinicians to have a more detailed understanding of a patient’s baseline. Those patients identified as frail could be admitted to an ICU level of care and more closely monitored and treated. Alternatively, some frail patients and their families may choose to focus more on comfort and quality of life after achieving a better understanding of a patient’s frailty and risk, changing the direction of care provided. Being able to identify the higher risk patients with an objective measure would allow clinicians to provide more personalized medicine.

Delayed Epidural Hematoma Demonstrated by Computed Tomography

Neurosurgery ◽  
1982 ◽  
Vol 10 (4) ◽  
pp. 487-489 ◽  
Author(s):  
Z. Harry Rappaport ◽  
Itzchak Shaked ◽  
Rina Tadmor
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Head Trauma ◽  
Epidural Hematoma ◽  
Neurological Deterioration ◽  
Trauma Patients ◽  
The Face ◽  
High Level

Abstract A case of delayed visualization of an acute parietal epidural hematoma by computed tomography (CT) in a child is presented. The initial CT 2½ hours after injury was negative. After neurological deterioration, a repeat CT scan 8 hours postinjury demonstrated a parietal epidural hematoma and a small cerebellar hematoma. The case demonstrates the need for a high level of vigilance in head trauma patients even in the face of an initially negative CT scan.

Abstract 147: Hypertension-related Admission and Mortality at a Referral Hospital in Tanzania - A Call to Action

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Naomi Shike ◽  
Santosh Vardhana ◽  
Judith Briant ◽  
Robert Peck
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Tertiary Care ◽  
Sub Saharan Africa ◽  
Morbidity And Mortality ◽  
Hospital Death ◽  
Care Hospital ◽  
Common Cause ◽  
Related Disease ◽  
Reasonable Approach

Introduction The WHO has been increasingly emphasizing and calling for research on the vast unattended burden of non-communicable diseases in the developing world. Hypertension (HTN) in particular is thought to play a growing role in morbidity and mortality in these regions, but has yet to gain significant momentum in public health initiatives. Objective To determine what role HTN and comorbid diseases play in admission and mortality in Bugando Medical Center (BMC), a tertiary care hospital in Tanzania serving 13 million people. Methods We conducted a retrospective analysis of all patients admitted to the internal medicine service at BMC over 34 months between 2008 and 2011. Data on admission diagnoses and mortality had been collected prospectively by Tanzanian doctors in hand-written logs. For patients with heart failure or stroke, the ward logs specified if this was primarily related to hypertension or other risk factors. Data were copied into an Excel database and analyzed to determine the proportion of admissions and deaths primarily related to hypertension. Results In 34 months 8,037 patients were admitted and 1,508 died. HTN-related disease led to 1,997 admissions (25%), while HIV-related illness led to 2,076 (26%). Similarly, HTN led to 377 deaths (25%) and HIV to 579 (38%). HTN-related disease was second only to HIV-related disease as a cause of admission and death. Among hypertensives, the most common cause of admission was congestive heart failure (446; 27%) and of death was stroke (147; 49%). In non-hypertensives, HIV-related disease was the most common cause of both admission (2029; 32%) and death (566; 46%). Conclusions HTN-related disease was second only to HIV as a cause of admission to our hospital and in-hospital death. Better strategies for early diagnosis and treatment of HTN are desperately need in sub Saharan Africa to prevent this morbidity and mortality. Building HTN screening and treatment on top of the extensive infrastructure for HIV disease may be a reasonable approach.

scholarly journals Outcomes of Craniofacial Open Surgery in Octogenarians

2018 ◽  
Vol 79 (06) ◽  
pp. 515-521
Author(s):  
Barak Ringel ◽  
Narin Carmel-Neiderman ◽  
Daniel Ben-Ner ◽  
Aviyah Pery ◽  
Ahmad Safadi ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Medical Center ◽  
Morbidity And Mortality ◽  
Wound Complications ◽  
Steady Increase ◽  
Systemic Complications ◽  
Female Ratio ◽  
Younger Patients ◽  
Surgery In Octogenarians

Introduction The steady increase in average life expectancy has led to a rise in the number of referrals of elderly patients for major operations. It is not clear whether age itself is a risk factor for morbidity and mortality after skull base operations. We investigated a possible link among a cohort of patients older than 80 years of age who underwent those surgeries in our department. Methods We conducted a retrospective analysis of all patients who underwent skull base surgery at the TASMC (Tel Aviv Sourasky Medical Center) between 2000 and 2016. Results A total of 369 patients underwent open skull base surgeries in our institution, and 13 were patients older than 80 years. The median age of the octogenarians was 83.4 (range 80–89), and the male-to-female ratio was 7:6. Twelve patients had major systemic comorbidities. Four patients had major complications associated with surgery: three had early wound complications, and one each had early central nervous system complications, early and late systemic complications, and late orbital complications. This complication rate is comparable to that of our younger group of 356 patients. The overall survival rate was measured for 30 days, 1 year, and 3 years, and it was not significantly different between the octogenarians and that of the younger patients. Further comparison of the elderly group with 13 matched younger patients revealed no difference of morbidity and mortality between the two groups. Conclusions Despite their systemic comorbidities, the morbidity and mortality rates associated with skull base surgery in octogenarians appear to be comparable to that of younger patients undergoing the same procedures.

An Eight-Year Analysis of Surgical Morbidity and Mortality: Data and Solutions

2006 ◽  
Vol 72 (11) ◽  
pp. 1070-1081
Author(s):  
Michael A. Goldfarb ◽  
Thomas Baker
Keyword(s):  
Surgical Outcome ◽  
Medical Center ◽  
Morbidity And Mortality ◽  
Mortality Data ◽  
Time Process ◽  
Operative Techniques ◽  
Barriers To Adoption ◽  
Surgical Morbidity ◽  
Technical Complications ◽  
Common Problems

In this article, a reproducible process for presenting, analyzing, and reducing early and late surgical morbidity and mortality (M&M) is detailed. All M&M cases presented from 1998 through 2005 at Monmouth Medical Center were categorized. Residents and nurses were empowered to report the complications. The five major categories were overwhelming disease on admission, delays in treatment, diagnostic or judgment complications, treatment complications, and technical complications. From the 53,541 operations performed over 8 years, 714 patients were presented, which included 147 deaths and 1,132 category entries. The most common problems were technical complications in 474 (66.4%) patients. The data have generated actionable solutions, many with low barriers to adoption, resulting in safer, less expensive surgical management. Surgical outcome benchmarks have been established and are used for credentialing surgeons. The “Hostile Abdomen Index” has been developed to assess the safest choice for abdominal operative access, pre- and intraoperatively. We explained the real-time process that generated solutions for the entire department as well as changes relevant to residency training and individual operative techniques.

scholarly journals Management of Occult Hypoperfusion Syndrome in Trauma Patients: A Narrative Review

2020 ◽  
Vol 9 (3) ◽  
pp. 1-12
Author(s):  
Krishna Prasad G V
Keyword(s):  
Management Practices ◽  
Traumatic Injury ◽  
Lactate Concentration ◽  
Central Venous Oxygen Saturation ◽  
Serum Lactate ◽  
Review Article ◽  
Morbidity And Mortality ◽  
Trauma Patients ◽  
Negative Results ◽  
Patients At Risk

Occult hypoperfusion (OH) is connected with higher levels of morbidity and mortality after trauma. Occult hypoperfusion, defined as serum lactate concentration of more than 2.5 mmol / L persisting in the intensive care unit for more than 12 hours after admission. This refers to the reversible risk factor for negative results after traumatic injury. Occult hypoperfusion can be observed and patients at risk of complications should be classified other than frequently regulated metrics (blood pressure and heart rate), central venous oxygen saturation, and blood lactate levels. An elevated hospital duration of stay (LOS) and a greater incidence of postoperative difficulties are linked with OH. The focus of this review article is to assess the different approaches and methods involved in the management of OH syndrome in trauma patients. Identification of OH treatment methods can be helpful in reducing morbidity in patients with various injuries. The outcomes from this review article may prove beneficial to patients by rapid resuscitation and aggressive monitoring of OH. These management practices will severely reduce OH-associated morbidity and mortality. LOS, ICU readmission incidence and post-operative complications per patient was decreased by early treatment of OH.

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