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Radiographic assessment of sarcopenia in the trauma setting: a systematic review
  1. Daniel M Zumsteg1,
  2. Caleb Everett Chu1,
  3. Mark John Midwinter1,2
  1. 1School of Biomedical Sciences, University of Queensland Faculty of Medicine and Biomedical Sciences, Brisbane, Queensland, Australia
  2. 2Jamieson Trauma Institute, MetroNorth Hopsital and Health Service, Brisbane, Queensland, Australia
  1. Correspondence to Professor Mark John Midwinter, School of Biomedical Sciences, The University of Queensland, Brisbane, QLD 4072, Australia; m.midwinter{at}


Background Compared with similarly injured patients of a younger age, elderly patients have worse outcomes from acute injury. One factor adversely affecting outcomes is sarcopenia, which has been assessed in healthy elderly populations through established clinical and radiological criteria. However, in the acute care setting, no such criteria have been established. Sarcopenia has been opportunistically assessed via radiographic means but there is as of yet no gold standard. The purpose of this review is to summarize the radiological methods used to diagnose sarcopenia in the acute care setting, and suggest ways in which these methods may lead to a consensus definition of sarcopenia and its relationship to patient outcomes.

Methods A systematic survey of medical databases was conducted, with 902 unique publications identified. After screening and application of inclusion and exclusion criteria, data regarding study population, outcome, imaging modality, and criteria for assessment of sarcopenia were extracted from 20 studies. Quality was assessed with the Newcastle-Ottawa Scale.

Results CT was the imaging modality for 18 of the studies, with total psoas muscle cross-sectional area at the level of L3 and L4 being the dominant method for assessing sarcopenia. Adjustment for body morphology most commonly used patient height or L4 vertebral body area. The majority of articles found radiographically assessed sarcopenia to be significantly correlated to outcomes such as mortality, length of hospital stay, morbidity, and in-hospital complications

Conclusions Establishing a consistent definition would strengthen its applicability and generalizability to admission and discharge planning.

Level of evidence Systematic review, level III.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors All authors developed the protocol from the original idea from MJM. DMZ and CEC extracted the relevant literature from the search and all authors analyzed the data and wrote the article draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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