Tillquist Maggie, Kutsogiannis Demetrios J, Wischmeyer Paul E, Kummerlen Christine, Leung Roger, Stollery Daniel, Karvellas Constantine J, Preiser Jean-Charles, Bird Nora, Kozar Rosemary, Heyland Daren K
Brigham and Women's Hospital, Boston, MA, USA.
University of Alberta, Edmonton, AB, Canada.
JPEN J Parenter Enteral Nutr. 2014 Sep;38(7):886-90. doi: 10.1177/0148607113501327. Epub 2013 Aug 26.
Critically ill patients commonly experience skeletal muscle wasting that may predict clinical outcome. Ultrasound is a noninvasive method that can measure muscle quadriceps muscle layer thickness (QMLT) and subsequently lean body mass (LBM) at the bedside. However, currently the reliability of these measurements are unknown. The objectives of this study were to evaluate the intra- and interreliability of measuring QMLT using bedside ultrasound.
Ultrasound measurements of QMLT were conducted at 7 centers on healthy volunteers. Trainers were instructed to perform measurements twice on each patient, and then a second trainee repeated the measurement. Intrarater reliability measured how consistently the same person measured the subject according to intraclass correlation (ICC). Interrater reliability measured how consistently trainer and trainee agreed when measuring the same subject according to the ICC.
We collected 42 pairs of within operator measurements with an ICC of .98 and 78 pairs of trainer-to-trainee measurements with an ICC of .95. There were no statistically significant differences between the trainer and trainee results (trainer and trainee mean = -0.028 cm, 95% CI = -0.067 to -0.011, P = .1607).
Excellent intra- and interrater reliability for ultrasound measurements of QMLT in healthy volunteers was observed when performed by a range of providers with no prior ultrasound experience, including dietitians, nurses, physicians, and research assistants. This technique shows promise as a method to evaluate LBM status in ICU or hospital settings and as a method to assess the effects of nutrition and exercise-based interventions on muscle wasting.
危重症患者常出现骨骼肌萎缩，这可能预示临床结局。超声是一种非侵入性方法，可在床边测量股四头肌层厚度（QMLT），进而测量瘦体重（LBM）。然而，目前这些测量的可靠性尚不清楚。本研究的目的是评估使用床边超声测量QMLT的内部和外部可靠性。
在7个中心对健康志愿者进行QMLT的超声测量。培训人员被指示对每位患者进行两次测量，然后另一名实习人员重复测量。内部评估者可靠性根据组内相关系数（ICC）衡量同一人测量受试者的一致性程度。外部评估者可靠性根据ICC衡量培训人员和实习人员在测量同一受试者时的一致程度。
我们收集了42对同一操作人员的测量数据，ICC为0.98，以及78对培训人员与实习人员的测量数据，ICC为0.95。培训人员和实习人员的结果之间无统计学显著差异（培训人员和实习人员平均值=-0.028 cm，95%CI=-0.067至-0.011，P=0.1607）。
当由包括营养师、护士、医生和研究助理在内的一系列无超声经验的人员进行操作时，观察到健康志愿者QMLT超声测量具有出色的内部和外部评估者可靠性。该技术有望成为评估重症监护病房（ICU）或医院环境中LBM状态的方法，以及评估基于营养和运动的干预措施对肌肉萎缩影响的方法。
