Dataset Information

Bedside Ultrasound of Quadriceps to Predict Rehospitalization and Functional Decline in Hospitalized Elders.

ABSTRACT:

Objective

To evaluate the capacity of total anterior thigh thickness, quadriceps muscle thickness, and quadriceps contractile index, all measured by bedside ultrasound, to predict rehospitalization, functional decline, and death in elderly patients 3?months after hospital discharge. To evaluate intra and interobserver reproducibility of the dominant thigh evaluation method by point of care ultrasound.

Methods

Cohort study of patients aged 65?years or more admitted to a medium complexity unit in a teaching hospital in southern Brazil. Comprehensive geriatric assessment and ultrasound evaluation of the dominant thigh of each participant were performed. After 3?months of hospital discharge, telephone contact was made to evaluate the outcomes of rehospitalization or death and functional decline-assessed by the 100 points Barthel scale and defined as a decrease of five or more points.

Results

100 participants were included. There was no statistically significant difference between intraobserver measurements in the GEE method analysis (p?>?0.05), and the mean bias obtained in Bland-Altman plots was close to zero in all four analyses performed, suggesting good intra and interobserver agreement. There was a significant correlation between the echographic measurements (quadriceps thickness and contractile index) and gait speed, timed up and go, and handgrip tests. There was a significant association between contractile index (quadriceps thickness over total anterior thigh thickness multiplied by 100) lower than 60% and functional decline (relative risk 1.35; CI 95% 1.10-1.65; p?=?0.003) as well as between the thickness of the quadriceps and rehospitalization or death, in both individuals with preserved walking capacity and in bedridden elders (relative risk 1.34; CI 95% 1.02-1.75; p?=?0.04).

Conclusion

The ultrasonographic method to evaluate thigh thickness was easily applicable and reproducible. The thickness of the quadriceps could predict rehospitalization or death, even in those patients without walking capacity-unable to perform gait speed and timed up and go tests. Additionally, the contractile index was associated with functional decline after 3?months of hospital discharge. This is a promising result, which highlights the bedside ultrasound of the quadriceps as a potential tool for the prognosis evaluation of bedridden hospitalized elderly patients.

SUBMITTER: Guerreiro AC

PROVIDER: S-EPMC5535297 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Bedside Ultrasound of Quadriceps to Predict Rehospitalization and Functional Decline in Hospitalized Elders.

Guerreiro Ana Clara AC Tonelli Ana Claudia AC Orzechowski Roman R Dalla Corte Roberta Rigo RR Moriguchi Emilio Hideyuki EH de Mello Renato Bandeira RB

Frontiers in medicine 20170731

<h4>Objective</h4>To evaluate the capacity of total anterior thigh thickness, quadriceps muscle thickness, and quadriceps contractile index, all measured by bedside ultrasound, to predict rehospitalization, functional decline, and death in elderly patients 3 months after hospital discharge. To evaluate intra and interobserver reproducibility of the dominant thigh evaluation method by point of care ultrasound.<h4>Methods</h4>Cohort study of patients aged 65 years or more admitted to a medium comp ...[more]

PMID: 28824911

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Project description:BackgroundWe developed a clinical bedside tool to simultaneously estimate the probabilities of third-generation cephalosporin-resistant Enterobacteriaceae (3GC-R), carbapenem-resistant Enterobacteriaceae (CRE), and multidrug-resistant Pseudomonas aeruginosa (MDRP) among hospitalized adult patients with Gram-negative infections.MethodsData were obtained from a retrospective observational study of the Premier Hospital that included hospitalized adult patients with a complicated urinary tract infection (cUTI), complicated intra-abdominal infection (cIAI), hospital-acquired/ventilator-associated pneumonia (HAP/VAP), or bloodstream infection (BSI) due to Gram-negative bacteria between 2011 and 2015. Risk factors for 3GC-R, CRE, and MDRP were ascertained by multivariate logistic regression, and separate models were developed for patients with community-acquired versus hospital-acquired infections for each resistance phenotype (N = 6). Models were converted to a singular user-friendly interface to estimate the probabilities of a patient having an infection due to 3GC-R, CRE, or MDRP when ≥ 1 risk factor was present.ResultsOverall, 124,068 patients contributed to the dataset. Percentages of patients admitted for cUTI, cIAI, HAP/VAP, and BSI were 61.6, 4.6, 16.5, and 26.4%, respectively (some patients contributed > 1 infection type). Resistant infection rates were 1.90% for CRE, 12.09% for 3GC-R, and 3.91% for MDRP. A greater percentage of the resistant infections were community-acquired relative to hospital-acquired (CRE, 1.30% vs 0.62% of 1.90%; 3GC-R, 9.27% vs 3.42% of 12.09%; MDRP, 2.39% vs 1.59% of 3.91%). The most important predictors of having an 3GC-R, CRE or MDRP infection were prior number of antibiotics; infection site; infection during the previous 3 months; and hospital prevalence of 3GC-R, CRE, or MDRP. To enable application of the six predictive multivariate logistic regression models to real-world clinical practice, we developed a user-friendly interface that estimates the risk of 3GC-R, CRE, and MDRP simultaneously in a given patient with a Gram-negative infection based on their risk (Additional file 1).ConclusionsWe developed a clinical prediction tool to estimate the probabilities of 3GC-R, CRE, and MDRP among hospitalized adult patients with confirmed community- and hospital-acquired Gram-negative infections. Our predictive model has been implemented as a user-friendly bedside tool for use by clinicians/healthcare professionals to predict the probability of resistant infections in individual patients, to guide early appropriate therapy.

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Dataset Information

Bedside Ultrasound of Quadriceps to Predict Rehospitalization and Functional Decline in Hospitalized Elders.

Objective

Methods

Results

Conclusion

Publications

Bedside Ultrasound of Quadriceps to Predict Rehospitalization and Functional Decline in Hospitalized Elders.

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