Body mass composition in polytrauma – Does it help to predict the clinical course?

Abstract text (incl. references and figure legends)

Background: Body mass composition (BC) correlates well with patient outcome but data regarding patients with multiple trauma (MT) is sparse. BC is calculated using computed tomography (CT) which is routinely performed in severely injured patients. Aside BC analysis on the level of the established 3rd lumbar vertebra level, this study will also investigate results on the 4th thoracic vertebra level as thoracic trauma is common in MT patients.

Materials/Methods: MT-patients (ISS>15) admitted to a level 1 trauma center were included. All received whole-body CT (WBCT) scan on admission. Muscle and fat tissue were assessed at the level of the 4th thoracic vertebra (T4) and the 3rdlumbar vertebra (L3) by using the software Slice-O-matic, version 5.0 (Tomovision, Montreal, QC, Canada) to detect potential correlations in regard to outcome parameters (duration of ventilation, hospital stay, local (i.e. pneumonia, wound infection) and systemic (i.e. MODS, SIRS) complications and mortality).

Results: BC (low muscle mass and high visceral adipose tissue) variables correlated well with overall complication severity. T4 and L3 values predicted the severity of complications roughly the same way. Skeletal muscle radiation attenuation (SMRA) at L3, skeletal muscle index (SMI) and subcutaneous adipose tissue index (SATI) showed a significant association with the occurrence of systemic infections. Local infections presented an association with skeletal muscle index at T4 . Moreover, higher muscle mass at the T4 and the L3 level associated significantly with higher overall survival. Additionally, a statistically significant correlation of SATI at T4 level with hospital stay, length of stay in the ICU, and duration of ventilation was observed.

Conclusion: Assessment of BC variables in MT is simple and helps to predict outcome. Moreover, information gained on T4 level offered comparable results to validated L3 level.

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