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.

The Effect of Sarcopenia on Outcomes in Geriatric Blunt Trauma

2017 ◽  
Vol 83 (11) ◽  
pp. 1203-1208 ◽  
Author(s):  
Mahdi Malekpour ◽  
Kelly Bridgham ◽  
Kathryn Jaap ◽  
Ryan Erwin ◽  
Kenneth Widom ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Confidence Interval ◽  
Blunt Trauma ◽  
Odds Ratio ◽  
Lumbar Vertebra ◽  
Objective Measure ◽  
Trauma Patients ◽  
The Third ◽  
Increased Risk ◽  
Axial Ct

Elderly patients are at a higher risk of morbidity and mortality after trauma, which is reflected through higher frailty indices. Data collection using existing frailty indices is often not possible because of brain injury, dementia, or inability to communicate with the patient. Sarcopenia is a reliable objective measure for frailty that can be readily assessed in CT imaging. In this study, we aimed to evaluate the effect of sarcopenia on the outcomes of geriatric blunt trauma patients. Left psoas area (LPA) was measured at the level of the third lumbar vertebra on the axial CT images. LPA was normalized for height (LPA mm2/m2) and after stratification by gender, sarcopenia was defined as LPA measurements in the lowest quartile. A total of 1175 patients consisting of 597 males and 578 females were studied. LPAs below 242.6 mm2/m2 in males and below 187.8 mm2/m2 in females were considered to be sarcopenic. We found sarcopenia in 149 males and 145 females. In multivariate analysis, sarcopenia was associated with a higher risk of in-hospital mortality (odds ratio [OR]: 1.61, 95% confidence interval [CI]: 1.01–2.56) and a higher risk of discharge to less favorable destinations (OR: 1.42, 95% CI: 1.05–1.97). Lastly, sarcopenic patients had an increased risk of prolonged hospitalization (hazard ratio: 1.21, 95% CI: 1.04–1.40).

Treatment With Oral Versus Intravenous Acetaminophen in Elderly Trauma Patients With Rib Fractures: A Prospective Randomized Trial

2020 ◽  
Vol 86 (8) ◽  
pp. 926-932
Author(s):  
Andrew C. Antill ◽  
Sarah W. Frye ◽  
James C. McMillen ◽  
James C. Haynes ◽  
Benjamin R. Ford ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Pain Score ◽  
Study Groups ◽  
Oral Solution ◽  
Rib Fractures ◽  
Trauma Patients ◽  
Opioid Use ◽  
Increased Risk ◽  
Significant Difference ◽  
Elderly Trauma Patients

Background Rib fractures are common injuries among traumatically injured patients, and elderly patients with rib fractures are at increased risk for adverse events and death. The purpose of this study was to determine if oral Per os (PO) acetaminophen is as effective as intravenous (IV) acetaminophen in treating the pain associated with rib fractures. Methods We performed a single-center, randomized, placebo-controlled, double-blinded study. Trauma patients who were ≥65 years old and had ≥1 rib fracture were included in this study. Patients were randomized into IV acetaminophen and oral placebo (n = 63) or IV placebo and oral solution acetaminophen (n = 75) groups. The primary outcome was a mean reduction in pain score at 24 hours, and secondary outcomes included opioid use, intensive care unit (ICU) length of stay (LOS), hospital LOS, hospital mortality, the difference in incentive spirometry, and development of pneumonia. Results Among the 138 patients included, there was no statistically significant difference between the 2 study groups in a mean reduction in pain score at 24 hours after injury (PO: 3.24, IV: 2.49; P = .230). Opioid pain medication use was equivalent between groups ( P = .212), and there was no significant difference in hospital mortality rate between groups ( P = .827). There was no statistically significant difference in ICU LOS, hospital LOS, or development of pneumonia. Discussion In elderly trauma patients (age ≥65 years) with 1 or more rib fractures, PO acetaminophen is equivalent to IV acetaminophen for pain control, with no difference in morbidity or mortality. Oral acetaminophen should be preferentially used over IV acetaminophen when treating the elderly trauma patient with rib fractures.

Characterization of unplanned 30-day medical oncology readmissions after discharge at an academic medical center with a comprehensive cancer center.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 269-269 ◽  
Author(s):  
Inga Tolin Lennes ◽  
Justin Eusebio ◽  
Nie Bohlen ◽  
Margaret Ruddy ◽  
David P. Ryan
Keyword(s):  
Readmission Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Unplanned Readmission ◽  
Oncology Patient ◽  
Hematopoietic Stem ◽  
Medical Oncologists ◽  
Increased Risk

269 Background: Hospital readmission rate is increasingly suggested as a quality care metric. Currently there are no standard criteria for an avoidable readmission in oncology. Although patients with cancer have been identified as being at increased risk of readmission, there has been little to examine the reasons for the oncology patient readmission. The aim was to examine the profiles of patients with an unplanned readmission within 30 days after discharge by an oncology provider and to measure the unplanned 30-day readmission rate. Methods: A retrospective review of oncology provider discharge encounters resulting in a 30-day unplanned readmission during the 2012 calendar year at a tertiary hospital with a comprehensive cancer center was conducted. Planned readmissions for chemotherapy, radiation therapy, hematopoietic stem cell transplantation, dialysis, and surgical procedures, as well as readmissions for rehabilitation, hospice, and psychiatry were excluded. Medical oncologists analyzed medical records for the primary reason of readmission and if the readmission was possibly preventable. Results: Of the 2,944 admissions, a final cohort of 441 unplanned readmissions from 321 unique patients for an unplanned 30-day readmission rate of 14.9% was observed. The average age at admission was 59 (SD 15.9). The cohort was mostly male (56.9%) and White/Caucasian (84.4%). Gastrointestinal (24.0%), lymphoma (18.6%), and leukemia (17.5%) were the most common cancer types. Of those with solid tumors types (n = 225), approximately 70% had metastatic disease. The median time to readmission was 10 days and 10.7% died within 30 days of readmission. Oncology reviewers most commonly assessed that readmission was primarily due to treatment-related effects (46.7%) and the progression of disease (42.2%). Approximately 20% of 30-day readmissions were determined to be possibly preventable, representing 3% of all admissions for the year. Conclusions: Oncology patients readmitted within 30-days frequently present with complicated, advanced disease. A review by medical oncologists suggests there is margin for intervention to reduce 30-day unplanned admissions.

Impact of sarcopenia evaluated using the total psoas area (TPA) in patients undergoing Y-90 radioembolization for hepatocellular carcinoma (HCC).

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 217-217
Author(s):  
Pericles Ioannides ◽  
Yazan Abuodeh ◽  
Will Jin ◽  
Sarah E. Hoffe ◽  
Jessica M. Frakes ◽  
...  
Keyword(s):  
Overall Survival ◽  
Median Survival ◽  
Psoas Muscle ◽  
Final Analysis ◽  
Ct Imaging ◽  
High Group ◽  
Cross Sectional ◽  
Entire Cohort ◽  
Risk Of Mortality ◽  
Increased Risk

217 Background: Severe skeletal muscle depletion, or sarcopenia, is an independent predictor of clinical outcomes in multiple gastrointestinal cancers. This marker of nutritional status has been defined using the TPA which is measured on a single cross sectional CT image at the L4 vertebral body level. We sought to evaluate whether TPA was predictive of outcomes in those patients with unresectable HCC receiving Y-90 radioembolization. Methods: In an IRB approved database consisting of HCC patients treated with Y-90 radioembolization, 111 patients met our selection criteria of treatment from 2009-2014. To be eligible for the study, patients were included prior to their first injection of Y-90 if they had CT imaging available that included the L4 vertebral level that could be transferred to the treatment planning software system. Of these, 73 patients met criteria and were included in the final analysis. The L4 vertebra was identified on axial CT imaging and the psoas muscle was manually contoured bilaterally. Sarcopenia was defined by the presence of the psoas area in less than the median of the cohort. Results: Sarcopenia was associated with a significantly decreased overall survival (p = 0.013) The mean age of the cohort was 67.6 years (range, +/- 9.45) consisting of 84% male and 16% female patients. Difference in age or gender did not correlate significantly with survival. The median survival time in the “low” (sarcopenic) group was 10.46 months (range, +/- 1.21), whereas the median survival in the “high” group was 18.02 months (range, +/-4.26). The median survival for the entire cohort was 12.86 months. OS at 30 months was 15.4% in the sarcopenic group and 30.2 % in the “high” group. TPA in the upper quartile was associated with a survival benefit compared to the bottom quartiles. The presence of sarcopenia was associated with an increased risk of mortality (HR = 2.049; p = 0.015 CI: 01.150, 3.649). Conclusions: Measurement of the psoas area using TPA is a simple objective method to detect frailty and is predictive of overall survival outcome following Y-90 radioembolization

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.

Safety and efficacy of stereotactic radiosurgery for tumors of the spine

2004 ◽  
pp. 413-418 ◽  
Author(s):  
Deborah L. Benzil ◽  
Mehran Saboori ◽  
Alon Y. Mogilner ◽  
Ronald Rocchio ◽  
Chitti R. Moorthy
Keyword(s):  
Spinal Cord ◽  
Single Dose ◽  
Pain Relief ◽  
Total Dose ◽  
Stereotactic Radiosurgery ◽  
Medical Center ◽  
Primary Tumors ◽  
Content Type ◽  
Increased Risk ◽  
Fine Print

Object. The extension of stereotactic radiosurgery treatment of tumors of the spine has the potential to benefit many patients. As in the early days of cranial stereotactic radiosurgery, however, dose-related efficacy and toxicity are not well understood. The authors report their initial experience with stereotactic radiosurgery of the spine with attention to dose, efficacy, and toxicity. Methods. All patients who underwent stereotactic radiosurgery of the spine were treated using the Novalis unit at Westchester Medical Center between December 2001 and January 2004 are included in a database consisting of demographics on disease, dose, outcome, and complications. A total of 31 patients (12 men, 19 women; mean age 61 years, median age 63 years) received treatment for 35 tumors. Tumor types included 26 metastases (12 lung, nine breast, five other) and nine primary tumors (four intradural, five extradural). Thoracic tumors were most common (17 metastases and four primary) followed by lumbar tumors (four metastases and four primary). Lesions were treated to the 85 to 90% isodose line with spinal cord doses being less than 50%. The dose per fraction and total dose were selected on the basis of previous treatment (particularly radiation exposure), size of lesion, and proximity to critical structures. Conclusions. Rapid and significant pain relief was achieved after stereotactic radiosurgery in 32 of 34 treated tumors. In patients treated for metastases, pain was relieved within 72 hours and remained reduced 3 months later. Pain relief was achieved with a single dose as low as 500 cGy. Spinal cord isodoses were less than 50% in all patients except those with intradural tumors (mean single dose to spinal cord 268 cGy and mean total dose to spinal cord 689 cGy). Two patients experienced transient radiculitis (both with a biological equivalent dose (BED) > 60 Gy). One patient who suffered multiple recurrences of a conus ependymoma had permanent neurological deterioration after initial improvement. Pathological evaluation of this lesion at surgery revealed radiation necrosis with some residual/recurrent tumor. No patient experienced other organ toxicity. Stereotactic radiosurgery of the spine is safe at the doses used and provides effective pain relief. In this study, BEDs greater than 60 Gy were associated with an increased risk of radiculitis.

scholarly journals Psychosocial interventions to support the mental health of informal caregivers of persons living with dementia – a systematic literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Henrik Wiegelmann ◽  
Sarah Speller ◽  
Lisa-Marie Verhaert ◽  
Liane Schirra-Weirich ◽  
Karin Wolf-Ostermann
Keyword(s):  
Mental Health ◽  
Informal Caregivers ◽  
Psychosocial Interventions ◽  
Health Interventions ◽  
Subjective Burden ◽  
Dementia Caregivers ◽  
Targeted Interventions ◽  
Positive Effects ◽  
Increased Risk ◽  
Mental Health Interventions

Abstract Background Informal caregivers of persons living with dementia have an increased risk of adverse mental health effects. It is therefore important to systematically summarize published literature in order to find out which mental health interventions generate effective support for informal caregivers of persons living with dementia. The objective of this study is to conduct a systematic review of intervention content, effectiveness and subgroup differentiation of mental health interventions for informal caregivers of persons with dementia living at home. Method We searched four electronic databases (PubMed, PsychINFO, Scopus and CINAHL) and included only methodically high-quality randomized controlled trials (RCTs), published in English or German language between 2009 and 2018. The intervention programmes focused on mental health of family caregivers. A narrative synthesis of the included studies is given. Results Forty-eight publications relating to 46 intervention programmes met the inclusion criteria. Burden, depression and quality of life (QoL) are the predominant parameters that were investigated. Twenty-five of forty-six interventions (54.3%) show positive effects on at least one of the outcomes examined. Most often, positive effects are reported for the outcome subjective burden (46.2%). Only six studies explicitly target on a certain subgroup of informal dementia caregivers (13%), whereas all other interventions (87%) target the group as a whole without differentiation. Conclusion The most beneficial results were found for cognitive behavioural approaches, especially concerning the reduction of depressive symptoms. Besides this, leisure and physical activity interventions show some good results in reducing subjective caregiver burden. In order to improve effectiveness, research and practice may focus on developing more targeted interventions for special dementia informal caregiver subgroups.

scholarly journals Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty

2021 ◽  
Vol 6 (1) ◽  
pp. e000639
Author(s):  
Danielle Ní Chróinín ◽  
Nevenka Francis ◽  
Pearl Wong ◽  
Yewon David Kim ◽  
Susan Nham ◽  
...  
Keyword(s):  
Older Patients ◽  
Multivariable Analysis ◽  
Primary Outcome Measure ◽  
Hospital Length ◽  
Assessment Tools ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Increased Risk ◽  
History Of

BackgroundGiven the increasing numbers of older patients presenting with trauma, and the potential influence of delirium on outcomes, we sought to investigate the proportion of such patients who were diagnosed with delirium during their stay—and patient factors associated therewith—and the potential associations between delirium and hospital length of stay (LOS). We hypothesized that delirium would be common, associated with certain patient characteristics, and associated with long hospital LOS (highest quartile).MethodsWe conducted a retrospective observational cohort study of all trauma patients aged ≥65 years presenting in September to October 2019, interrogating medical records and the institutional trauma database. The primary outcome measure was occurrence of delirium.ResultsAmong 99 eligible patients, delirium was common, documented in 23% (23 of 99). On multivariable analysis, adjusting for age, frailty and history of dementia, frailty (OR 4.09, 95% CI 1.08 to 15.53, p=0.04) and dementia (OR 5.23, 95% CI 1.38 to 19.90, p=0.02) were independently associated with likelihood of delirium. Standardized assessment tools were underused, with only 34% (34 of 99) screened within 4 hours of arrival. On univariate logistic regression analysis, having an episode of delirium was associated with long LOS (highest quartile), OR of 5.29 (95% CI 1.92 to 14.56, p<0.001). In the final multivariable model, adjusting for any (non-delirium) in-hospital complication, delirium was independently associated with long LOS (≥16 days; OR 4.81, p=0.005).DiscussionIn this study, delirium was common. History of dementia and baseline frailty were associated with increased risk. Delirium was independently associated with long LOS. However, many patients did not undergo standardized screening at admission. Early identification and targeted management of older patients at risk of delirium may reduce incidence and improve care of this vulnerable cohort. These data are hypothesis generating, but support the need for initiatives which improve delirium care, acknowledging the complex interplay between frailty and other geriatric syndromes in the older trauma patients.Level of evidenceIII.

scholarly journals Radiation Dose and Volume to the Pancreas and Subsequent Risk of Diabetes Mellitus: A Report from the Childhood Cancer Survivor Study

2019 ◽  
Vol 112 (5) ◽  
pp. 525-532 ◽  
Author(s):  
Danielle Novetsky Friedman ◽  
Chaya S Moskowitz ◽  
Patrick Hilden ◽  
Rebecca M Howell ◽  
Rita E Weathers ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Radiation Dose ◽  
Childhood Cancer ◽  
Statistical Tests ◽  
Pancreatic Head ◽  
Diabetes Risk ◽  
Cardiometabolic Health ◽  
Pancreatic Tail ◽  
Targeted Interventions ◽  
Increased Risk

Abstract Background Childhood cancer survivors exposed to abdominal radiation (abdRT) are at increased risk for diabetes mellitus, but the association between risk and radiation dose and volume is unclear. Methods Participants included 20 762 5-year survivors of childhood cancer (4568 exposed to abdRT) and 4853 siblings. For abdRT, we estimated maximum dose to abdomen; mean doses for whole pancreas, pancreatic head, body, tail; and percent pancreas volume receiving no less than 10, 20, and 30 Gy. Relative risks (RRs) were estimated with a Poisson model using generalized estimating equations, adjusted for attained age. All statistical tests were two-sided. Results Survivors exposed to abdRT (median age = 31.6 years, range = 10.2–58.3 years) were 2.92-fold more likely than siblings (95% confidence interval [CI] = 2.02 to 4.23) and 1.60-times more likely than survivors not exposed to abdRT (95%CI = 1.24 to 2.05) to develop diabetes. Among survivors treated with abdRT, greater attained age (RRper 10 years = 2.11, 95% CI = 1.70 to 2.62), higher body mass index (RRBMI 30+ = 5.00, 95% CI = 3.19 to 7.83 with referenceBMI 18.5–24.9), and increasing pancreatic tail dose were associated with increased diabetes risk in a multivariable model; an interaction was identified between younger age at cancer diagnosis and pancreatic tail dose with much higher diabetes risk associated with increasing pancreatic tail dose among those diagnosed at the youngest ages (P &lt; .001). Radiation dose and volume to other regions of the pancreas were not statistically significantly associated with risk. Conclusions Among survivors treated with abdRT, diabetes risk was associated with higher pancreatic tail dose, especially at younger ages. Targeted interventions are needed to improve cardiometabolic health among those at highest risk.

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