Feasibility and Reliability of Muscle Strength Testing in Critically Ill Children

Kaitlyn Siu; Samah Al-Harbi; Heather Clark; Lehana Thabane; Ji Cheng; Mark Tarnopolsky; Brandon Meaney; Karen Choong

doi:10.1055/s-0035-1563544

Journal of Pediatric Intensive Care, Table of Contents

J Pediatr Intensive Care 2015; 04(04): 218-224
DOI: 10.1055/s-0035-1563544

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Feasibility and Reliability of Muscle Strength Testing in Critically Ill Children

Authors

Kaitlyn Siu

¹Division of Pediatric Neurology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
Samah Al-Harbi

²Division of Pediatric Critical Care, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
Heather Clark

²Division of Pediatric Critical Care, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
Lehana Thabane

³Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
Ji Cheng

³Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
Mark Tarnopolsky

⁴Division of Neuromuscular and Neurometabolic Disease, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
Brandon Meaney

¹Division of Pediatric Neurology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
Karen Choong

²Division of Pediatric Critical Care, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada

Abstract

Diagnosing pediatric intensive care unit–acquired weakness (PICU-AW) is challenging. The Medical Research Council (MRC) score is a widely used screening method for muscle weakness in critically ill adults; however, its utility in critically ill children has not been established. Our objective was to determine the feasibility and interobserver reliability of muscle strength testing using MRC score in critically ill children. A prospective observational substudy of critically ill children aged 1 to 17 years and limited to bed rest during the first 48 hours of PICU admission was evaluated with weekly MRC exams independently performed by two clinical raters. MRC exams were attempted on all 33 participants, but could be completed in only 21 (64%), 9 of who (43%) received at least one exam while in the PICU, and in the remaining 12 (57%), MRC exams could only be completed after PICU discharge. Of the 95 attempted MRC exams, 55 (57%) could not be conducted or completed, most commonly due to patient sedation, and inability to comply due to cognitive ability, pain, or noncooperation. The inter-rater reliability for MRC sum score was excellent (intraclass correlation coefficient: 0.87). However, the inter-rater reliability was only moderate when used to determine PICU-AW (Cohen kappa: 0.48). MRC testing in the PICU was not feasible as an early screening tool for muscle weakness in the majority of critically ill children in this study. Further research is needed to find an appropriate screening tool that is both feasible and predicts clinically relevant outcomes in children, such as function and recovery following critical illness.

Keywords

pediatrics - critical illness - muscle strength testing - muscle weakness - neuromuscular disorder - reliability

Full Text

References

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