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
Processing time: 328 Days and 3.5 Hours
ARTICLE HIGHLIGHTS
Research background

Nurses can measure quadriceps muscle thickness using ultrasonography (USG). However, the data regarding the reliability of such measurements are sparse.

Research motivation

The inclusion of USG for assessment of quadriceps muscle thickness on a daily basis would add, remarkably, to the workload on intensive care unit (ICU) physicians. Reliable measurement of quadriceps muscle thickness by USG from nurse operators would reduce the workload of physicians working in the ICU.

Research objectives

To evaluate the reliability of measurements of quadriceps muscle thickness using USG data obtained by critical care-setting nurses.

Research methods

In this cross-sectional observational study, 5 operators (comprised of 1 critical care consultant, 2 fellows, and 2 nurses) independently measured quadriceps muscle thickness on ICU patients by using USG. The experience of using USG was variable among the 5 operators. The consultant and 2 fellows had experience of > 5 years and 2 years, respectively. Both nurses were naïve to USG, and they were provided a short training course involving 5-10 patients before the actual start of the study. Each operator took three readings of each patient’s quadriceps muscles thickness on USG, independently. Assessment of agreement for measurements taken by all 5 operators was done by computing the intraclass correlation coefficient (ICC) and expressed with the corresponding 95% confidence interval (CI).

Research results

We included 45 critically ill patients in this study. The quadriceps muscle thickness measured by the 2 nurses closely resembled those obtained by the critical care consultant and 2 fellows. The overall ICC (95%CI) for interoperator agreement for the 1st, 2nd and 3rd readings were 0.977 (0.965, 0.986; P < 0.001), 0.974 (0.960, 0.984; P < 0.001) and 0.975 (0.961, 0.985; P < 0.001) respectively.

Research conclusions

Critical care nurses can measure quadriceps muscle thickness on bedside USG, with their measurements having excellent reliability when compared to those from a critical care consultant and fellows.

Research perspectives

The current study adds to the expanding body of literature on the use of bedside USG in critical care settings. The study’s results suggest that nurses in the ICU setting may successfully perform USG assessment of quadriceps muscle thickness. Feasibility of a nurses-led assessment of quadriceps muscle thickness should be explored further in studies involving larger populations of staff and patients and more various critical care settings.