González-Seguel Felipe, Molina Jorge, Ríos-Castro Francisco
Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
Rev Med Chil. 2023 Sep;151(9):1153-1163. doi: 10.4067/s0034-98872023000901153.
Muscle ultrasound is a valid tool to monitor muscle mass loss in critically ill patients. The level of experience is essential to the accuracy of the measurements.
To evaluate the interobserver reliability of experienced and novice raters measuring muscle thickness and echo intensity of the quadriceps and tibialis anterior.
Cross-sectional observational study. Twenty-four critical care physiotherapists participated (5 experienced and 19 novice). Following a standardized ultrasound protocol, each rater measured the thickness (centimeters) of the quadriceps and tibialis anterior of 10 healthy and young models using linear and convex probes of portable devices. The Intraclass Correlation Coefficient and the Minimal Detectable Change (95% confidence interval) were calculated. Additionally, the novices scored the echo intensity of 19 muscle ultrasound images of critically ill patients using the Heckmatt score (qualitative assessment). The agreement with experienced raters was evaluated (Spearman Rho).
960 muscle thickness measurements were performed (experienced = 200 and novice = 760). The mean thickness of the quadriceps and tibialis anterior was 4.4 ± 0.77 and 2.4 ± 0.35 centimeters for the experienced and 4.2 ± 0.80 and 2.2 ± 0.39 centimeters for the novices, respectively. Quadriceps' and tibialis' anterior reliability were 0.82 and 0.86 for experienced and 0.76 and 0.41 for novices, respectively. The Minimal Detectable Change ranged from 0.14-0.33 centimeters. The mean Heckmatt score was 2.6 ± 0.83 points, with a reliability of 0.68 and an agreement with the experimenters of 0.78 [p < 0.001].
Interobserver reliability was excellent for experienced raters and moderate to good for novice raters. The level of experience could determine the reliability of the results.
肌肉超声是监测重症患者肌肉量减少的有效工具。经验水平对测量的准确性至关重要。
评估经验丰富的评估者和新手评估者测量股四头肌和胫骨前肌肌肉厚度及回声强度时的观察者间可靠性。
横断面观察性研究。24名重症护理物理治疗师参与（5名经验丰富的和19名新手）。按照标准化超声方案，每位评估者使用便携式设备的线性和凸阵探头测量10名健康年轻模型的股四头肌和胫骨前肌厚度（厘米）。计算组内相关系数和最小可检测变化（95%置信区间）。此外，新手使用赫克马特评分（定性评估）对19例重症患者的肌肉超声图像的回声强度进行评分。评估与经验丰富的评估者的一致性（斯皮尔曼等级相关系数）。
共进行了960次肌肉厚度测量（经验丰富的评估者 = 200次，新手 = 760次）。经验丰富的评估者测量的股四头肌和胫骨前肌平均厚度分别为4.4±0.77厘米和2.4±0.35厘米，新手分别为4.2±0.80厘米和2.2±0.39厘米。经验丰富的评估者测量股四头肌和胫骨前肌的可靠性分别为0.82和0.86，新手分别为0.76和0.41。最小可检测变化范围为0.14 - 0.33厘米。赫克马特评分的平均分为2.6±0.83分，可靠性为0.68，与实验者的一致性为0.78 [p < 0.001]。
经验丰富的评估者的观察者间可靠性极佳，新手评估者的可靠性为中等至良好。经验水平可决定结果的可靠性。
