A pilot study examining the use of ultrasound to measure sarcopenia, frailty and fall in older patients

Benton, Emily A.; Liteplo, Andrew S.; Shokoohi, Hamid; Loesche, Michael A.; Yacoub, Sarah; Thatphet, Phraewa; Wongtangman, Thiti; Liu, Shan W.

doi:10.1016/j.ajem.2020.07.081

Cited by 20 publications

(13 citation statements)

References 37 publications

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“…Participation in the ED VOU Falls program will not preclude concomitant care or interventions. The follow-up questions will be adapted from previous ED fall studies [ 44 , 45 ].…”

Section: Methodsmentioning

confidence: 99%

A protocol to determine the acceptability and feasibility of a pilot intervention emergency department virtual observation unit fall prevention program

Jones,

Kennedy,

Hayden

et al. 2024

Pilot Feasibility Stud

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Background As a third of all community dwellers aged 65+ fall each year, falls are common reasons for older adults to present to an Emergency Department (ED). Although EDs should assess patients’ multifactorial fall risks to prevent future fall-related injuries, this frequently does not occur. We describe our protocol to determine the feasibility, acceptability, and safety of a pilot ED Virtual Observation Unit (VOU) Falls program. Methods To ensure standardized conduct and reporting, the Standard Protocol Items for Intervention Trials (SPIRIT) guidelines will be used. The VOU is a program where patients are sent home from the ED but are part of a virtual observation unit in that they can call on-call ED physicians while they are being treated for conditions such as cellulitis, congestive heart failure, or pneumonia. A paramedic conducts daily visits with the patient and facilitates a telemedicine consult with an ED physician. VOU nursing staff conduct daily assessments of patients via telemedicine. The ED VOU Falls program is one of the VOU pathways and is a multi-component fall prevention program for fall patients who present after an ED visit. The paramedic conducts a home safety evaluation, a Timed Up and Go Test (TUG). During the VOU visit, the ED physician conducts a telemedicine visit, while the paramedic is visiting the home, to review patients' fall-risk-increasing drugs and their TUG test. We will determine feasibility by calculating rates of patient enrollment refusal, and adherence to fall-risk prevention recommendations using information from 3-month follow-up telephone calls, as well as qualitative interviews with the paramedics. We will determine the acceptability of the ED VOU Falls program based on patient and provider surveys using a Likert scale. We will ask VOU nursing staff to report any safety issues encountered while the patient is in the ED VOU Falls program (e.g., tripping hazards). We will use the chi-square test or Fisher’s exact test for categorical variables, Student’s t-test for continuous variables, and Mann-Whitney for nonparametric data. We will review interview transcripts and generate codes. Codes will then be extracted and organized into concepts to generate an overall theme following grounded theory methods. This is a pilot study; hence, results cannot be extrapolated. However, a definite trial would be the next step in the future to determine if such a program could be implemented as part of fall prevention interventions. Discussion This study will provide insights into the feasibility and acceptability of a novel ED VOU Falls program with the aim of ultimately decreasing falls. In the future, such a program could be implemented as part of fall prevention interventions.

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“…Participation in the ED VOU Falls program will not preclude concomitant care or interventions. The follow-up questions will be adapted from previous ED fall studies [ 44 , 45 ].…”

Section: Methodsmentioning

confidence: 99%

A protocol to determine the acceptability and feasibility of a pilot intervention emergency department virtual observation unit fall prevention program

Jones,

Kennedy,

Hayden

et al. 2024

Pilot Feasibility Stud

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“… Ref. [ 33 ] Thigh muscle thickness measurement. ST = subcutaneous tissue; RF = rectus femoris; VI = vastus intermedius; QT; quadricep’s thickness.…”

Section: Figurementioning

confidence: 99%

“…In a pilot study [ 33 ], we showed that older ED patients with subsequent falls had smaller quadriceps muscles. However, no study has measured the association between POCUS-measured muscle mass and previous falls among ED patients.…”

Section: Introductionmentioning

confidence: 99%

Association of Sonographic Sarcopenia and Falls in Older Adults Presenting to the Emergency Department

Wongtangman

Thatphet

Shokoohi

et al. 2023

JCM

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Background and Objective: To determine the association between point-of-care-ultrasonography (POCUS)-measured sarcopenia and grip strength, as well as the history of prior-year falls among older adults admitted to the emergency department observation unit (EDOU). Materials and Methods: This cross-sectional observational study was conducted over 8 months at a large urban teaching hospital. A consecutive sample of patients who were 65 years or older and admitted to the EDOU were enrolled in the study. Using standardized techniques, trained research assistants and co-investigators measured patients’ biceps brachii and thigh quadriceps muscles via a linear transducer. Grip strength was measured using a Jamar Hydraulic Hand Dynamometer. Participants were surveyed regarding their history of falls in the prior year. Logistic regression analyses assessed the relationship of sarcopenia and grip strength to a history of falls (the primary outcome). Results: Among 199 participants (55% female), 46% reported falling in the prior year. The median biceps thickness was 2.22 cm with an Interquartile range [IQR] of 1.87–2.74, and the median thigh muscle thickness was 2.91 cm with an IQR of 2.40–3.49. A univariate logistic regression analysis demonstrated a correlation between higher thigh muscle thickness, normal grip strength, and history of prior-year falling, with an odds ratio [OR] of 0.67 (95% conference interval [95%CI] 0.47–0.95) and an OR of 0.51 (95%CI 0.29–0.91), respectively. In multivariate logistic regression, only higher thigh muscle thickness was correlated with a history of prior-year falls, with an OR of 0.59 (95% CI 0.38–0.91). Conclusions: POCUS-measured thigh muscle thickness has the potential to identify patients who have fallen and thus are at high risk for future falls.

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“…To date, the most common populations where sarcopenia is found are in the elderly and in cancer patients. For the former, muscle function is critical and provides insight into patient activity and mobility, which are essential for sustained health [14]. For cancer patients, there is a strong correlation between poor treatment outcomes and muscle mass and quality, which reflect fat infiltration [15,16].…”

Section: Introductionmentioning

confidence: 99%

Open-Ended Transmission Coaxial Probes for Sarcopenia Assessment

Meaney

Geimer

diFlorio-Alexander

et al. 2022

Sensors

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We developed a handheld, side-by-side transmission-based probe for interrogating tissue to diagnose sarcopenia—a condition largely characterized by muscle loss and replacement by fat. While commercial microwave reflection-based probes exist, they can only be used in a lab for a variety of applications. The penetration depth of these probes is only in the order of 0.3 mm, which does not even traverse the skin layer, and minor motion of the coaxial feedlines can completely dismantle the calibration. Our device builds primarily on the transmission-based concept that allows for substantially greater signal penetration depth operating over a very broad bandwidth. Additional features were integrated to further improve the penetration, optimize the geometry for a more focused planar excitation, and juxtapose the coaxial apertures for more controlled interrogation. The larger coaxial apertures further increased the penetration depth while retaining the broadband performance. Three-dimensional printing technology made it possible for the apertures to be compressed into ellipses for interrogation in a near-planar geometry. Finally, fixed side-by-side positioning provided repeatable and reliable performance. The probes were also not susceptible to multipath signal corruption due to the close proximity of the transmitting and receiving apertures. The new concept worked from 100 MHz to over 8 GHz and could sense property changes as deep as 2–3 cm. While the signal changes due to deeper feature aberrations were more subtle than for signals emanating from the skin and subcutaneous fat layers, the large property contrast between muscle and fat is a sarcopenic indication that helps to distinguish even the deepest objects. This device has the potential to provide needed specificity information about the relevant underlying tissue.

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A pilot study examining the use of ultrasound to measure sarcopenia, frailty and fall in older patients

Cited by 20 publications

References 37 publications

A protocol to determine the acceptability and feasibility of a pilot intervention emergency department virtual observation unit fall prevention program

A protocol to determine the acceptability and feasibility of a pilot intervention emergency department virtual observation unit fall prevention program

Association of Sonographic Sarcopenia and Falls in Older Adults Presenting to the Emergency Department

Open-Ended Transmission Coaxial Probes for Sarcopenia Assessment

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