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Computed tomographic bone mineral density is independently associated with adverse in-hospital outcomes in Dutch level-1 trauma patients

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Abstract

Background

Aging, inactivity, and malnutrition are risk factors for adverse in-hospital outcomes and can manifest in bone loss. Use of bone mineral density (BMD) as an objective marker might improve early identification of patients at risk for complications.

Aim

To assess the association of computed tomography (CT) determined BMD values of the first lumbar vertebra with in-hospital complications and outcomes in trauma patients.

Methods

All consecutive hospitalized trauma patients (≥ 16 years) that underwent CT-imaging within 7 days of admission in 2017 were included. Patients with an active infection or antibiotic treatment upon admission, severe neurologic trauma, or an unassessable vertebra were excluded. BMD at the first lumbar vertebra was determined with CT by placing a circular region of interest in homogeneous trabecular bone to obtain mean Hounsfield Units (HU). Regression analyses were performed to assess the association of BMD with in-hospital complications and outcomes.

Results

In total, 410 patients were included (median age: 49 years [interquartile range 30–64], 68.3% men, mean BMD 159 ± 66 HU). A total of 94 complications, primarily infection-related, were registered in 74 patients. After adjustment for covariates, a decrease of BMD by one standard deviation was significantly associated with increased risk of complications (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1–3.1), pneumonia (OR 2.2, 95% CI 1.2–4.5), delirium (OR 4.5, 95% CI 1.7–13.5), and intensive care unit (ICU) admission (OR 1.8, 95% CI 1.1–2.9).

Conclusion

Bone mineral density of the first lumbar vertebra is independently associated with in-hospital complications, pneumonia, delirium, and ICU admission. These findings could help identify patients at risk early.

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Data availability

The study data will not be made available.

Abbreviations

ASA:

American Society of Anesthesiologists

BMD:

Bone mineral density

CI:

Confidence interval

CT:

Computed tomography

DMV:

Days on mechanical ventilation

GOS:

Glasgow Outcome Scale

HLOS:

Hospital length of stay

HU:

Hounsfield Units

ICU:

Intensive care unit

ILOS:

ICU length of stay

IQR:

Interquartile range

ISS:

Injury Severity Score

L1/L2:

First/second lumbar vertebra

OR:

Odds ratio

ROI:

Region of interest

SD:

Standard deviation

Th12:

Twelfth thoracic vertebra

UMCU:

University Medical Center Utrecht

UTI:

Urinary tract infection

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Acknowledgements

Our special thanks go out to Sandra A Wilson for her help in reviewing the manuscript on grammar and linguistics. Her efforts greatly increased the readability of the manuscript and the delivery of its message.

Funding

No funding was received in connection to this study.

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Authors and Affiliations

  1. Department of Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508GA, Utrecht, The Netherlands

    Tim Kobes, Arthur A. R. Sweet, Sophie B. H. Verstegen, R. Marijn Houwert, Luke P. H. Leenen & Mark C. P. M. van Baal

  2. Department of Radiology, University Medical Center Utrecht, P.O. Box 85500, 3508GA, Utrecht, The Netherlands

    Tim Kobes, Arthur A. R. Sweet, Wouter B. Veldhuis & Pim A. de Jong

Authors
  1. Tim Kobes
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Contributions

Conceptualization, all authors; methodology, TK, AS, PdJ, and MvB.; formal analysis, TK, and AS; investigation, TK, AS, and SV; writing—original draft preparation, TK, and AS; writing—review & editing, SV, RH, WV, LL, PdJ, and MvB; visualization, TK, and AS; supervision, RH, WV, LL, PdJ, and MvB. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Tim Kobes.

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Conflict of interest

None of the declarations of interest posed any conflict with conducting this study. Pim de Jong is a consultant for Sanifit and InoZyme. Wouter Veldhuis is co-founder of Quantib-U, a spin-off from the University Medical Center Utrecht. The Department of Radiology at the University Medical Center Utrecht is receiving research support from Philips Healthcare.

Ethical approval

Ethical approval was waived by the medical ethical committee of the University Medical Center Utrecht in view of the retrospective nature of the study and all the procedures being performed were part of routine care.

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Supplementary file1 (DOCX 26 KB)

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Kobes, T., Sweet, A.A.R., Verstegen, S.B.H. et al. Computed tomographic bone mineral density is independently associated with adverse in-hospital outcomes in Dutch level-1 trauma patients. Eur J Trauma Emerg Surg 49, 1393–1400 (2023). https://doi.org/10.1007/s00068-022-02175-8

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  • DOI: https://doi.org/10.1007/s00068-022-02175-8

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