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Armstrong W, Costa C, Poveda L, Miller AN, Ambrosini A, Hsu FC, Kiani B, Martin RS, Stitzel JD, Weaver AA. Effects of muscle quantity and bone mineral density on injury and outcomes in older adult motor vehicle crash occupants. Traffic Inj Prev 2022; 23:S86-S91. [PMID: 36190765 PMCID: PMC9839521 DOI: 10.1080/15389588.2022.2124864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Objectives: Quantify the independent and combined effects of abdominal muscle quantity and lumbar bone mineral density (BMD) on injury risk and in-hospital outcomes in severely injured motor vehicle crash (MVC) occupants ages 50 and older.Methods: Skeletal muscle area measurements of MVC occupants were obtained through semi-automated segmentation of an axial computed tomography (CT) slice at the L3 vertebra. An occupant height-normalized Skeletal Muscle Index (SMI) was calculated - a defining metric of sarcopenia and low muscle mass (sarcopenia thresholds: <38.5 cm2/m2 females; <52.4 cm2/m2 males). Lumbar BMD was obtained using a validated, phantomless CT calibration method (osteopenia threshold: <145 mg/cm3). SMI and BMD values were used to categorize occupants, and logistic regression was used to associate sarcopenia, osteopenia, and osteosarcopenia predictors to injury outcomes (e.g., Injury Severity Score (ISS), maximum Abbreviated Injury Scale (MAIS) score, fractures) and hospital outcomes (e.g., length of stay, ICU days).Results: Of the 336 occupants, 210 (63%) were female (mean ± SD: age 66.3 ± 10.6). SMI was 41.7 ± 8.0 cm2/m2 in females and 51.2 ± 10.8 cm2/m2 in males. Based on SMI, 40% of females and 55% of males were classified as sarcopenic. BMD was 163.2 ± 38.3 mg/cm3 in females and 164.1 ± 35.4 mg/cm3 in males, with 41% of females and 33% of males classified as osteopenic. Prevalence of both conditions (osteosarcopenia) was similar between females (21%) and males (22%). Incidence of low SMI and BMD increased with age. Sarcopenic individuals were less likely to sustain a MAIS 2+ thorax injury and had longer ICU stays. Osteopenic individuals were more likely to sustain upper extremity injuries and fractures, and were less likely to be discharged to a rehabilitation facility. Osteosarcopenic individuals were less likely to be ventilated or admitted to the ICU but tended to spend more time on the ventilator if placed on one.Conclusions: Osteosarcopenia was not associated with any injury outcomes, but sarcopenia was associated with thoracic injury and osteopenia was associated with upper extremity injury incidence. Sarcopenia was only associated with ICU length of stay, while osteopenia was only associated with discharge destination. Osteosarcopenia was associated with likelihood of being ventilated, being admitted to the ICU, and with increased length of ventilation.
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Affiliation(s)
- William Armstrong
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Ave., Winston-Salem, NC 27101, USA
| | - Casey Costa
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Ave., Winston-Salem, NC 27101, USA
| | - Luis Poveda
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Ave., Winston-Salem, NC 27101, USA
| | - Anna N. Miller
- Department of Orthopedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO 63110
| | - Alexander Ambrosini
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Ave., Winston-Salem, NC 27101, USA
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, 525 Vine St., Winston-Salem, NC 27101, USA
| | - Bahram Kiani
- Department of Radiology, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157
| | - R. Shayn Martin
- Department of Surgery, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157
| | - Joel D. Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Ave., Winston-Salem, NC 27101, USA
| | - Ashley A. Weaver
- Department of Biomedical Engineering, Wake Forest School of Medicine, 575 N. Patterson Ave., Winston-Salem, NC 27101, USA
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