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

Abstract

ObjectiveTo 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.MethodsCohort 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.Results100 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).ConclusionThe 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.

Age‐related changes in muscle elasticity and thickness of the lower extremities are associated with physical functions among community‐dwelling older women

“…5,29 Meanwhile, Guerreiro et al showed the relationships between these values in their study of hospitalized elderly individuals. 10 Compared with the present study, their average of muscle thickness, gait speed and TUG score was extremely low. Elderly women with relatively good physical function, such as the participants of the present study, might compensate for the decreased muscle thickness with other physical functions.…”

“…Although this does not support the hypothesis, some previous studies reported that the thickness of the quadriceps femoris was not correlated with gait speed or TUG score in elderly individuals . Meanwhile, Guerreiro et al showed the relationships between these values in their study of hospitalized elderly individuals . Compared with the present study, their average of muscle thickness, gait speed and TUG score was extremely low.…”

“…The muscle thickness of the quadriceps femoris is correlated with knee extension strength, 3 gait speed and Timed Up and Go test (TUG) score. 10 Meanwhile, the muscle elasticity is associated with muscle flexibility, 11 and the ankle plantar flexor flexibility is a predictor of dynamic balance ability and gait speed. 12 Furthermore, several authors reported that improvements of the ankle plantar flexor and hip flexor flexibility led to increased gait speed.…”

Neuromusculoskeletal Causes of Severe Disability in a Tertiary Hospital in Turkey

“…Our findings suggest that measurements of thigh MT are positively correlated with HGS, which is an indicator of upper extremity performance. Similarly, Guerreiro et al have demonstrated a significant association between quadriceps MT and HGS, gait speed and the TUGT (22). In the context of the literature data, our results suggest that ultrasonographic measurements of thigh MT can predict declines in the functional capacity of the lower extremity and loss of dynamic balance in the geriatric population.…”

Application of ultrasound for muscle assessment in sarcopenia: towards standardized measurements

“…• Rectus femoris was assessed in supine position in full extension [65,68,72,[76][77][78][79][80][81][82][83][84][85][86], with knees at 10° [87][88][89], in semi-Fowler position [90][91][92]. It was assessed in sitting position with hips and knees at 90° [66,93] and with hips at 90° and knees at 60° [94].…”