Akademik Veri Yönetim Sistemi
11. Avrasya Acil Tıp Kongresi / 21. Türk Acil Tıp Kongresi, Antalya, Türkiye, 20 - 23 Kasım 2025, (Özet Bildiri)
OBJECTIVE: Stroke remains a leading cause of mortality and disability worldwide, particularly among the elderly, who are at increased risk of poor outcomes. Sarcopenia, characterized by the loss of muscle mass and strength, is closely linked to frailty in this population. Temporal muscle thickness (TMT), an easily measurable parameter on cranial CT scans, reflects overall muscle mass and has emerged as a potential biomarker of sarcopenia. Reduced TMT has been associated with malnutrition, functional decline, and adverse outcomes in neurological disorders. This study investigates the relationship between TMT and in-hospital mortality in stroke patients aged 65 years and older presenting to the emergency department.
MATERIAL and METHODS: This retrospective cohort study was conducted in a tertiary university hospital, which also serves as a specialised stroke centre. The study included patients aged 65 years and over who presented to the emergency department with a stroke diagnosis. Patients with a history of trauma or surgery affecting the temporal region, those with inadequate CT image quality, those with missing retrospective data, and those in advanced cachectic states due to cancer or terminal systemic disease were excluded from the study. The TMT was measured using the initial brain CT scans taken at the time of stroke diagnosis. Demographic characteristics, medical history, baseline NIHSS scores, initial modified Rankin Scale scores, in-hospital mortality, and discharge status were recorded. The primary outcome was in-hospital mortality. The measurement of TMT was conducted on axial CT slices, employing methodologies that had previously been established. The measurements were obtained at the point of maximal thickness of the temporal muscle, which was located just above the orbitomeatal line and over the upper part of the temporal bone. The mean thickness of the bilateral temporal muscles was then utilised for the analysis. The image evaluations were performed by an experienced radiologist who was blinded to the clinical data, and the inter-rater reliability was assessed by a second observer in a randomly selected subgroup.
RESULT: A total of 699 patients with acute ischemic stroke were included. The median age was 77 years (IQR: 71–84), and 50.6% were female. The median TMT was 4 mm [3.1–4.9], and the in-hospital mortality rate was 17.7%. Deceased patients had significantly lower TMT values (3.25 mm [2.7–3.9] vs. 4.1 mm [3.3–5.1], p < 0.001). They were also older (p < 0.001) and had higher baseline i-mRS (p < 0.001) and NIHSS scores (p < 0.001). No sex difference was observed between groups (p = 0.35). Point-biserial correlation analysis revealed a positive, significant association between TMT and mortality (rpb = 0.225, p < 0.001), indicating that greater TMT was related to higher discharge rates and lower inhospital mortality. In multivariate logistic regression, TMT (β = 0.568, p < 0.001), age (β = –0.049, p = 0.014), sex (β = 0.716, p = 0.023), i-mRS (β = –0.332, p = 0.006), and NIHSS (β = –0.141, p < 0.001) were independent predictors of mortality. Each 1-mm increase in TMT increased the likelihood of discharge by 1.76-fold (OR = 1.76, 95% CI = 1.35–2.31). The model showed a good overall fit (LLR p < 0.001) with moderate explanatory power (Pseudo R² = 0.217).
CONCLUSION: This study demonstrates that TMT is significantly associated with in-hospital mortality in elderly stroke patients, supporting its potential use as an objective biomarker for prognosis. Reduced TMT may reflect sarcopenia and frailty, conditions known to worsen outcomes after stroke. Our findings align with previous research showing that muscle loss and malnutrition are independent predictors of poor outcomes in stroke populations. Incorporating TMT measurement from routine cranial CT scans may allow early identification of high-risk patients, enabling timely nutritional and rehabilitative interventions.
Keywords: stroke, temporal muscle, frailty