Dataset Information

Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study.

ABSTRACT:

Introduction

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.

Methods

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.

Results

Although the intra-class correlation coefficient (ICC) for MRC-SS in the ICU was 0.94 (95% CI 0.85-0.98), ? 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 ? 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).

Conclusions

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.

SUBMITTER: Connolly BA

PROVIDER: S-EPMC4057053 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Publications

Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study.

Connolly Bronwen A BA Jones Gareth D GD Curtis Alexandra A AA Murphy Patrick B PB Douiri Abdel A Hopkinson Nicholas S NS Polkey Michael I MI Moxham John J Hart Nicholas N

Critical care (London, England) 20131010 5

<h4>Introduction</h4>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 i ...[more]

PMID: 24112540

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Dataset Information

Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study.

Introduction

Methods

Results

Conclusions

Publications

Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study.

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