Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study.
Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study.
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DOI：
10.1186/cc13052
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发表时间：
2013-10-10
期刊：
影响因子：
--
通讯作者：
Hart N
中科院分区：
文献类型：
--
作者：
Connolly BA;Jones GD;Curtis AA;Murphy PB;Douiri A;Hopkinson NS;Polkey MI;Moxham J;Hart N
骨骼肌功能受损对危重病幸存者具有重要的临床结局意义。以往的研究采用意志手动肌肉测试诊断重症监护病房获得性无力（ICU-AW）在早期阶段的危重病只提供了有限的数据的结果。本研究旨在确定医学研究理事会总分（MRC-SS）测试在危重患者中的观察者间一致性和临床预测价值。研究1：将ICU内重症患者（n = 20）中两名临床医生之间的ICU-AW观察者间一致性与模拟演示（n = 20）进行比较。研究2：在连续ICU队列中，使用觉醒时的MRC-SS来确定ICU结局、住院死亡率和住院时间的临床预测值（n = 94）。尽管ICU中MRC-SS的类内相关系数（ICC）为0.94（95% CI 0.85-0.98），但ICU-AW（MRC-SS <48/60）诊断的κ统计量仅为0.60（95% CI 0.25-0.95）。模拟虚弱表现的一致性几乎完全一致（ICC 1.0（95% CI 0.99-1.0），κ统计量为1.0（95% CI 1.0-1.0））。未观察到进行MRC-SS的能力与临床结局之间存在关联，ICU-AW与死亡率之间也无关联。尽管ICU-AW对ICU（54.2%; 95% CI 39.2-68.6）和住院时间（66.7%; 95% CI 51.6-79.6）的阳性预测值有限，但ICU住院时间的阴性预测值在临床上可接受（88.2%; 95% CI 63.6-98.5）。这些数据突出了意志性肌力测试在危重患者中的有限临床适用性。在危重病的早期阶段，需要采用其他非意志性策略来评估和监测肌肉功能。
Impaired skeletal muscle function has important clinical outcome implications for survivors of critical illness. Previous studies employing volitional manual muscle testing for diagnosing intensive care unit-acquired weakness (ICU-AW) during the early stages of critical illness have only provided limited data on outcome. This study aimed to determine inter-observer agreement and clinical predictive value of the Medical Research Council sum score (MRC-SS) test in critically ill patients. Study 1: Inter-observer agreement for ICU-AW between two clinicians in critically ill patients within ICU (n = 20) was compared with simulated presentations (n = 20). Study 2: MRC-SS at awakening in an unselected sequential ICU cohort was used to determine the clinical predictive value (n = 94) for outcomes of ICU and hospital mortality and length of stay. Although the intra-class correlation coefficient (ICC) for MRC-SS in the ICU was 0.94 (95% CI 0.85–0.98), κ statistic for diagnosis of ICU-AW (MRC-SS <48/60) was only 0.60 (95% CI 0.25–0.95). Agreement for simulated weakness presentations was almost complete (ICC 1.0 (95% CI 0.99–1.0), with a κ statistic of 1.0 (95% CI 1.0–1.0)). There was no association observed between ability to perform the MRC-SS and clinical outcome and no association between ICU-AW and mortality. Although ICU-AW demonstrated limited positive predictive value for ICU (54.2%; 95% CI 39.2–68.6) and hospital (66.7%; 95% CI 51.6–79.6) length of stay, the negative predictive value for ICU length of stay was clinically acceptable (88.2%; 95% CI 63.6–98.5). These data highlight the limited clinical applicability of volitional muscle strength testing in critically ill patients. Alternative non-volitional strategies are required for assessment and monitoring of muscle function in the early stages of critical illness.
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影响因子：
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