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Computed tomography-derived muscle quantity and quality and clinical outcomes in older adults with multiple rib fractures: a sex-stratified observational study using the Korean Trauma Data Bank
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Chan Ik Park
 , Jayoung Yoo, Sora Kim, Junsik Kwon
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Received March 12, 2026 Accepted July 8, 2026 Published online November 3, 2026
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DOI: https://doi.org/10.15747/ACNM.26.0049
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 Abstract
- Purpose
This study examined associations of computed tomography (CT)-derived muscle quantity and quality with clinical outcomes in older adults with multiple rib fractures and potential differences by sex.
Methods
This retrospective study used Korean Trauma Data Bank data from 2016–2022. Patients were aged ≥65 years, had multiple rib fractures, and underwent abdominal CT within 7 days of presentation. Automated analysis measured skeletal muscle index (SMI), intermuscular adipose tissue ratio, and normal-attenuation muscle area ratio. Outcomes were in-hospital mortality, hospital length of stay (LOS), intensive care unit (ICU) LOS, and ventilator-free days to day 28 (VFD-28). Design-weighted multivariable models assessed associations overall and by sex; interaction tests assessed effect modification.
Results
Of 1,582 eligible patients, 238 were selected for CT body composition assessment. Muscle metrics showed no clear associations with mortality or ICU LOS. Per one weighted standard deviation increase in SMI, the adjusted geometric mean ratio for hospital LOS was 0.74 (95% confidence interval [CI], 0.60–0.92) in women and 0.98 (95% CI, 0.85 to 1.12) in men. Adjusted differences in VFD-28 were 1.8 days (95% CI, 0.4 to 3.2) in women and 0.5 days (95% CI, −1.0 to 1.9) in men. No sex interactions were statistically significant (SMI–VFD-28 interaction P=0.155).
Conclusion
Higher SMI was associated with shorter hospital LOS and more VFD-28 in women, without statistically significant evidence of effect modification by sex. These exploratory findings require confirmation.
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