Lean psoas area does not correlate with clinical outcomes in moderately to severely injured older people.

OBJECTIVE: Frailty has been associated with worse outcomes in older trauma patients. Specifically, the utility of lean cross-sectional psoas muscle area (LPA) was examined as a potentially simple objective measure of frailty. METHODS: Five hundred and fifty-four patients over the age of 65 were admitted with trauma between 2011 and 2014. Two hundred and twenty-five of these had adequate computed tomography imaging available for analysis. Cross-sectional area of the psoas muscle at the inferior endplate of L4 was quantified. RESULTS: Multivariate regression analysis showed no significant correlation between LPA and outcomes of mortality (P = 0.82) or inpatient complications (P = 0.22). Injury Severity Score (ISS) had a strong association with both mortality (odds ratio (OR) 9.5; 95% confidence interval (CI) 2.9-30.9) and inpatient complications (OR 9.9; 95% CI 3.5-27.7). Age also had an association with mortality (OR 1.09; 95% CI 1.03-1.16) and inpatient complications (OR 1.06; 95% CI 1.01-1.12). CONCLUSION: Lean psoas area was not an independent predictor of mortality or complications in a cohort of injured older patients.

Twenty-year review of abdominal aortic aneurysm screening in men in the county of Gloucestershire, United Kingdom.

OBJECTIVE: An ultrasound screening program for abdominal aortic aneurysms (AAAs) in men began in Gloucestershire in 1990 and has been running for 20 years. This report examines the workload and results. METHODS: We reviewed the screening database for attendance and outcome records from AAA surgery in Gloucestershire and postmortem and death certificate results looking for men who died from ruptured AAAs in the screening cohort. The setting was an AAA screening program in the county of Gloucestershire, UK. Men aged 65 were invited by year of birth to attend for an ultrasound screening for AAAs. Men with an aorta <2.6 cm were reassured and discharged; men with an aorta between 2.6 cm and 5.4 cm were offered follow-up surveillance; men with an aorta >5.4 cm were considered for intervention. We analyzed attendance rates, screening and surveillance outcomes, and intervention rates and outcomes over the 20 years of the study. RESULTS: Some 61,982 men were invited, and 52,690 attended for screening (85% attendance). At first scan, 50,130 men (95.14%) had an aortic diameter <2.6 cm in diameter and were reassured and discharged; 148 men (0.28%) had an AAA >5.4 cm in diameter and were referred for possible treatment; 2412 (4.57%) had an aortic diameter between 2.6 and 5.4 cm and entered a program of ultrasound surveillance. The overall mean aortic diameter on initial scan fell from 2.1 cm to 1.7 cm during the study (reduction 0.015 cm/y, 95% confidence interval [CI], 0.0144-0.0156 cm/y; P < .0001). Some 631 patients with AAAs had intervention treatment with a perioperative mortality rate of 3.9%; during the same interval, 372 AAAs detected incidentally were treated, with a mortality rate of 6.7%. The number of ruptured AAAs treated annually in Gloucestershire fell during the study (χ(2) for trend = 18.31, df = 1; P < .0001). CONCLUSIONS: Screening reduced the number of ruptured AAAs in Gloucestershire during the 20 years of the program. There has been a significant reduction of men with an abnormal aorta, as the mean aortic diameter of the 65-year-old male has reduced over 20 years.