Identifying Frailty Using Point-of-Care Ultrasonography: Image Acquisition and Assessment

Summary

Here, we present a protocol to assess frailty in the perioperative setting using point-of-care ultrasound to measure quadriceps thickness. This method offers a practical, non-invasive alternative to traditional assessment methods, potentially enhancing perioperative care by quickly identifying frail patients.

Abstract

Frailty is a significant predictor of a range of adverse outcomes in surgical patients, including increased mechanical ventilation time, longer hospital stays, unplanned readmissions, stroke, delirium, and death. However, accessible tools for screening in clinical settings are limited. Computed tomography of the psoas muscle is the current standard imaging device for measuring frailty, but it is expensive, time-consuming, and exposes the patient to ionizing radiation. Recently, the use of point-of-care ultrasound (POCUS) has emerged as a potential tool to determine the presence of frailty and has been shown to accurately predict frailty and postoperative outcomes. In this article, we will describe the image acquisition of the quadriceps muscles and explain how they can be used to determine frailty and predict postoperative adverse events. We will present information on probe selection, patient positioning, and troubleshooting. Images from a demonstration will be used to present the POCUS technique and example results. The article will culminate in a discussion of the use of these images in medical decision-making and potential limitations.

Introduction

As the average life expectancy rises globally, an increasing number of surgeries are performed on patients over the age of 65¹. Frailty is more common in these patients compared with their younger counterparts and represents a state of physiological vulnerability to stressors, including surgery^2,3,4. Frailty in the preoperative setting has been linked with a higher risk for postoperative adverse events across many surgical subspecialties^5,6,7,

Protocol

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

NOTE: The exams can be performed with either a low frequency curvilinear (2-5 MHz) or medium to high frequency linear probe (6-12 MHz) depending on patient body habitus, probe availability, and provider preference. For the figures and.......

Discussion

Previous studies have indicated that POCUS can be used to estimate muscle thickness, including the quadriceps muscle, with accuracy comparable to CT scans^26,27,28. Sonographic measurement of quadriceps muscle thickness has been correlated with frailty and can be used to predict certain postoperative outcomes²³. In addition, this method is helpful in situations where other methods of diagnosing frailty may.......

Materials

Name	Company	Catalog Number	Comments
High Frequency Ultrasound Probe (HFL38xp)	SonoSite (FujiFilm)	P16038
Low Frequency Ultrasound Probe (C35xp)	SonoSite (FujiFilm)	P19617
SonoSite X-porte Ultrasound	SonoSite (FujiFilm)	P19220
Ultrasound Gel	AquaSonic	PLI 01-08