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An optimal cut‐off point for the Chelsea Critical Care Physical Assessment Tool to diagnose intensive care unit‐acquired weakness in patients with mechanical ventilation: A multicentre observational study

Year: 2025

Type: article

Abstract: Background The Chelsea Critical Care Physical Assessment Tool ( CPAx ) may be an optimal tool for diagnosing intensive care unit‐acquired weakness ( ICU ‐ AW ). However, we do not know the cut‐off point for the diagnosis of ICU ‐ AW . Aim To ascertain the best cut‐off point for CPAx to diagnose ICU ‐ AW in adult patients with mechanical ventilation. Study Design A multicentre, prospective cross‐sectional study. Participants were recruited from five ICUs in China that ranged from 20 June 2021 to 31 July 2023. The Medical Research Council Sum Scale ( MRC ‐ss) <48 was taken as the standard to calculate the area under the curve ( AUC ) of CPAx . The cut‐off point was determined by the maximum value of Youden Index ( YI max ). The kappa (κ) test was used to test the consistency of the MRC ‐ss and CPAx . Results The AUC at baseline, weaning and discharge time point was 0.87 (95% CI 0.81–0.93), 0.96 (95% CI 0.92–0.99) and 0.91 (95% CI 0.86–0.96), respectively. Correspondingly, The YImax was 0.62, 0.91 and 0.65. The best cut‐off point of CPAx score to diagnose ICU ‐ AW at baseline, weaning and discharge time point was 30.5 (sensitivity = 72%, specificity = 89%), 31.5 (sensitivity = 95%, specificity = 90%) and 31.5 (sensitivity = 94%, specificity = 71%), respectively. Due to the CPAx being an ordinal scale, it was determined preliminarily that the cut‐off point for the CPAx to diagnose ICU ‐ AW was 31 points. We took CPAx ≤31 and MRC ‐ss <48 as criteria to diagnose ICU ‐ AW and test the consistency of MRC ‐ss and CPAx . The results showed that there was no significant difference in the incidence of ICU ‐ AW at different time points. Conclusions The optimal cut‐off point for the CPAx to diagnose ICU ‐ AW is a score of 31 and it has good sensitivity and specificity. Relevance to Clinical Practice The CPAx ≤31 score to diagnose ICU‐acquired weakness (ICU‐AW) has good sensitivity and specificity, and it can help to predict the risk of ICU‐AW and guide medical personnel to make interventions.

Source: Nursing in Critical Care

DOI: 10.1111/nicc.70018