title: Are frailty markers associated with serious thoracic and spinal injuries among motor vehicle crash occupants?
abstract: While age is a known risk factor in trauma, markers of frailty are growing in their use in the critically ill. Frailty markers may reflect underlying strength and function more than chronologic age, as many modern elderly patients are quite active. However, the optimal markers of frailty are unknown.
  
  
  
  A retrospective review of The Crash Injury Research and Engineering Network (CIREN) database was performed over an 11-year period. Computed tomographic images were analyzed for multiple frailty markers, including sarcopenia determined by psoas muscle area, osteopenia determined by Hounsfield units (HU) of lumbar vertebrae, and vascular disease determined by aortic calcification.
  
  
  
  Overall, 202 patients were included in the review, with a mean age of 58.5 years. Median Injury Severity Score was 17. Sarcopenia was associated with severe thoracic injury (62.9% vs. 42.5%; p = 0.03). In multivariable analysis controlling for crash severity, sarcopenia remained associated with severe thoracic injury (p = 0.007) and osteopenia was associated with severe spine injury (p = 0.05). While age was not significant in either multivariable analysis, the association of sarcopenia and osteopenia with development of serious injury was more common with older age.
  
  
  
  Multiple markers of frailty were associated with severe injury. Frailty may more reflect underlying physiology and injury severity than age, although age is associated with frailty.
  
  
  
  Prognostic and epidemiologic study, level IV.
authors.affiliation: From the Division of Critical Care, R Adams Cowley Shock Trauma Center (M.Q.O., M.H.L, T.M.S., D.M.S), University of Maryland School of Medicine, Baltimore, Maryland; National Study Center for Trauma and EMS (J.A.K., C.B., T.K., S.H.), University of Maryland School of Medicine; and Division of Radiology, R Adams Cowley Shock Trauma Center (K.S.), University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Morgan Q
authors.initials: MQ
authors.lastname: Oskutis
authors.forename: Margaret H
authors.initials: MH
authors.lastname: Lauerman
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Kufera
authors.forename: Kathirkamanathan
authors.initials: K
authors.lastname: Shanmuganathan
authors.forename: Cynthia
authors.initials: C
authors.lastname: Burch
authors.forename: Timothy
authors.initials: T
authors.lastname: Kerns
authors.forename: Shiu
authors.initials: S
authors.lastname: Ho
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Stein
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D005260:Female; D016330:Frail Elderly; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed