Intra- and inter-rater reproducibility of ultrasound imaging of patellar and quadriceps tendons in critically ill patients

PLoS One. 2019 Jun 27;14(6):e0219057. doi: 10.1371/journal.pone.0219057. eCollection 2019.

Abstract

Since the outset of body image reconstruction for diagnosis purposes, ultrasound has been used to investigate structural changes located in tendons. Ultrasound has clinical applications in the intensive care unit, but its utility for tendon imaging remains unknown. Thus, we aimed to determine intra- and inter-rater reproducibility of measures obtained by images generated through morphological tendon sonographic analysis recorded from critically ill patients. We designed a cross-sectional study to assess thickness, cross-sectional area, and echogenicity of patellar and quadriceps tendons in a convenience sample formed with 20 critically ill patients. Two independent raters (experienced and novice) recorded repeated measures, checking for agreement (Kappa statistics) and reliability (Intraclass coefficient Correlation-ICC and Bland-Altman). The quality of images acquired by the two independent raters substantially agreed (k = 0.571-1.000), regardless of the region on the patellar tendon or the studied tendon (patellar or quadriceps). Regardless of how much experience the rater had, their repeated records (intra-rater reliability) always demonstrated almost complete correlation, ICC ranging from 0.89 to 0.98 for both tendons in all outcomes. At the same way, the statistically significant inter-rater ICC ranging from 0.87 to 0.97. Both repeated measures by the raters (intra-rater) and the repeated single and double measures between the raters (inter-rater) presented a minimum measurement error constituting a predominant pattern of random variability. We conclude that ultrasound imaging acquisition performed by independent raters for tendon thickness, CSA, and echogenicity monitoring of critically ill patients are acceptable and are not influenced by rater experience.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Critical Illness
  • Cross-Sectional Studies
  • Female
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Muscular Atrophy / diagnostic imaging
  • Observer Variation
  • Patellar Ligament / diagnostic imaging*
  • Quadriceps Muscle / diagnostic imaging*
  • Reproducibility of Results
  • Tendons / diagnostic imaging*
  • Ultrasonography / methods*
  • Ultrasonography / statistics & numerical data

Grants and funding

This work was supported by the Fundação de Amparo à Pesquisa do Distrito Federal (FAPDF; Process number: 193.000.862/2014); Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq Process number: 447529/2014-5; 310359/2014-7) and by CAPES (Programa Ciências sem Fronteiras, Pesquisador Visitante Especial; Process number: 403 88881.068106/2014-01). This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.