Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Nov 19, 2019; 8(7): 127-134
Published online Nov 19, 2019. doi: 10.5492/wjccm.v8.i7.127
Assessment of quadriceps muscle thickness using bedside ultrasonography by nurses and physicians in the intensive care unit: Intra- and inter-operator agreement
Rohit Kumar, Tajamul Hussain Shah, Vijay Hadda, Pawan Tiwari, Saurabh Mittal, Karan Madan, Maroof Ahmad Khan, Anant Mohan
Rohit Kumar, Tajamul Hussain Shah, Vijay Hadda, Pawan Tiwari, Saurabh Mittal, Karan Madan, Anant Mohan, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
Maroof Ahmad Khan, Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India
Author contributions: Kumar R and Shah TH contributed equally in performance of the acquisition and analysis of the ultrasonography images; Hadda V designed the study, performed acquisition and analysis of the ultrasonography images, and wrote the manuscript; Tiwari P, Mittal S, Madan K and Mohan A contributed in critical appraisal of the study design, literature search, and editing of the manuscript; Khan MA performed the statistical analysis.
Institutional review board statement: The study protocol was approved by the institutional ethics committee of All India Institute of Medical Sciences, New Delhi, India (Ref. No. IEC-435/02.09.2016, RP-52/2016).
Informed consent statement: All study participants or their legal guardians provided written informed consent prior to participation in the study.
Conflict-of-interest statement: All authors state they have no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is 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 and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Vijay Hadda, MD, Assistant Professor, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. vijayhadda@yahoo.com
Telephone: +91-11-26546347 Fax: +91-11-26548663
Received: December 28, 2018
Peer-review started: December 29, 2018
First decision: June 7, 2019
Revised: August 29, 2019
Accepted: October 27, 2019
Article in press: October 27, 2019
Published online: November 19, 2019
Abstract
BACKGROUND

Data regarding the agreement among multiple operators for measurement of quadriceps muscle thickness by bedside ultrasonography (USG) are sparse.

AIM

To statistically assess the agreement among 5 operators for measurement of quadriceps muscle thickness on bedside USG.

METHODS

This was a cross-sectional observational study. The 5 operators of varied experience (comprised of 1 critical care consultant, 2 fellows, and 2 nurses) independently measured quadriceps muscle thickness in triplicate for 45 critically ill patients each, using USG. Intra- and interrater agreement rates among the 5 operators were assessed using intraclass correlation coefficient (ICC) and expressed with 95% confidence interval (CI).

RESULTS

The 5 operators produced a total of 135 readings and 675 observations for ICC calculations to determine the intraoperator and interoperator variations respectively. For intraoperator agreement, the overall ICC (95%CI) was 0.998 (0.997, 0.999) for operator 1, 0.998 (0.997, 0.999) for operator 2, 0.997 (0.995, 0.999) for operator 3, 0.999 (0.998, 0.999) for operator 4, and 0.998 (0.997, 0.999) for operator 5. For interoperator agreement, the overall ICC (95%CI) was 0.977 (0.965, 0.986; P < 0.001) for reading 1, 0.974 (0.960, 0.984; P < 0.001) for reading 2, and 0.975 (0.961, 0.985; P < 0.001) for reading 3.

CONCLUSION

USG measurement of quadriceps muscle thickness was not dependent on clinical experience, supporting training for nurses in it.

Keywords: Agreement, Intensive care unit, Critical illness, Muscle thickness, Quadriceps muscle, Ultrasonography

Core tip: Ultrasonography-measured quadriceps muscle thickness may be an early marker of adverse outcome among patients in the intensive care unit (ICU). However, while the technological approach is available for routine bedside use in the ICU, its application in daily care can increase the workload of ICU physicians. In this study, we found that quadriceps muscle thickness measurement by using ultrasonography can be done reliably by nurses, to a degree that is comparable to that of ICU fellows and a critical care consultant. These results suggest that nurses may be trained easily and used for ultrasonography measurement of quadriceps muscle thickness.