Feasibility, reliability, and clinical utility of skeletal muscle assessment with A-mode ultrasonography in hospitalized patients with burns

Frederiek G Bosch; Harriët Jager-Wittenaar; Gretha C Wesseling-Keuning; Jakob Hiddingh; Hans J Eshuis; Cees P van der Schans; Anuschka S Niemeijer; Marianne K Nieuwenhuis

doi:10.1016/j.burns.2025.107673

Feasibility, reliability, and clinical utility of skeletal muscle assessment with A-mode ultrasonography in hospitalized patients with burns

Frederiek G Bosch
, Harriët Jager-Wittenaar
, Gretha C Wesseling-Keuning
, Jakob Hiddingh
, Hans J Eshuis
, Cees P van der Schans
, Anuschka S Niemeijer
, Marianne K Nieuwenhuis

Healthy Ageing, Allied Health Care and Nursing

Association of Dutch Burn Centers
Radboud University Medical Center, Department of Gastroenterology and Hepatology, Dietetics
Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy, Experimental Anatomy Research Group
Martini Hospital, Department of Dietetics
University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine
University of Groningen, University Medical Center Groningen, Department of Health Science, Health Psychology Section
University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: Amplitude-mode (A-mode) ultrasonography is a promising technique to monitor loss and recovery of skeletal muscle in patients with burns. However, its clinimetric properties are unknown. Therefore, we determined its feasibility, interrater, and intrarater reliability, and clinical utility.

METHODS: Skeletal muscle thickness of upper arms and legs was assessed longitudinally in hospitalized adult patients with ≥ 5 % total body surface area (TBSA) burns, by pairs of two out of five raters. Feasibility was evaluated by % successful assessments, reliability by intra-class correlation coefficients (ICCs), and clinical utility by smallest detectable change (SDC).

RESULTS: Thirty-four patients participated (77 % male; mean age 48 ± 17 y, median TBSA burned 12 % [IQR 7-19]). Images were acquired on 69 % of planned occasions, and 89 % of images could be analyzed. Overall interrater ICCs were ≥ 0.84 (for pairs: 0.63-0.99) and intrarater ICCs were ≥ 0.95 (for pairs: 0.45-0.99). The overall interrater SDC was ≤ 33 % of the measured mean (for pairs: 3-52 %), while intrarater SDC was ≤ 20 % (for pairs: 3-48 %). All five raters could measure legs with moderate to excellent reliability, whereas for arms some demonstrated poor reliability.

CONCLUSION: A-mode ultrasonography assessment of skeletal muscle in patients with burns is feasible. However, reliability and clinical utility are rater-dependent; therefore we recommend assessments by the same rater.

Original language	English
Article number	107673
Journal	Burns : journal of the International Society for Burn Injuries
Volume	51
Issue number	8
Early online date	19 Aug 2025
DOIs	https://doi.org/10.1016/j.burns.2025.107673
Publication status	Published - 20 Aug 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 03 Good Health and Well-being
SDG 17 Partnerships for the Goals

Keywords

Bedside ultrasonography
Catabolism
Muscle wasting
Skeletal muscle mass
burns

Research Focus Areas Hanze University of Applied Sciences * (mandatory by Hanze)

Healthy Ageing

Research Focus Areas Research Centre or Centre of Expertise * (mandatory by Hanze)

Frailty and adequate care

Publinova themes

Other

Access to Document

10.1016/j.burns.2025.107673Licence: CC BY

Cite this

Bosch, F. G., Jager-Wittenaar, H., Wesseling-Keuning, G. C., Hiddingh, J., Eshuis, H. J., van der Schans, C. P., Niemeijer, A. S., & Nieuwenhuis, M. K. (2025). Feasibility, reliability, and clinical utility of skeletal muscle assessment with A-mode ultrasonography in hospitalized patients with burns. Burns : journal of the International Society for Burn Injuries, 51(8), Article 107673. https://doi.org/10.1016/j.burns.2025.107673

@article{cda492cb5de941e5a2e10a763c2a978d,

title = "Feasibility, reliability, and clinical utility of skeletal muscle assessment with A-mode ultrasonography in hospitalized patients with burns",

abstract = "OBJECTIVES: Amplitude-mode (A-mode) ultrasonography is a promising technique to monitor loss and recovery of skeletal muscle in patients with burns. However, its clinimetric properties are unknown. Therefore, we determined its feasibility, interrater, and intrarater reliability, and clinical utility.METHODS: Skeletal muscle thickness of upper arms and legs was assessed longitudinally in hospitalized adult patients with ≥ 5 \% total body surface area (TBSA) burns, by pairs of two out of five raters. Feasibility was evaluated by \% successful assessments, reliability by intra-class correlation coefficients (ICCs), and clinical utility by smallest detectable change (SDC).RESULTS: Thirty-four patients participated (77 \% male; mean age 48 ± 17 y, median TBSA burned 12 \% [IQR 7-19]). Images were acquired on 69 \% of planned occasions, and 89 \% of images could be analyzed. Overall interrater ICCs were ≥ 0.84 (for pairs: 0.63-0.99) and intrarater ICCs were ≥ 0.95 (for pairs: 0.45-0.99). The overall interrater SDC was ≤ 33 \% of the measured mean (for pairs: 3-52 \%), while intrarater SDC was ≤ 20 \% (for pairs: 3-48 \%). All five raters could measure legs with moderate to excellent reliability, whereas for arms some demonstrated poor reliability.CONCLUSION: A-mode ultrasonography assessment of skeletal muscle in patients with burns is feasible. However, reliability and clinical utility are rater-dependent; therefore we recommend assessments by the same rater.",

keywords = "Bedside ultrasonography, Catabolism, Muscle wasting, Skeletal muscle mass, burns, brandwonden, echografie aan het bed, katabolisme, skeletspiermassa, spierverspilling",

author = "Bosch, \{Frederiek G\} and Harri{\"e}t Jager-Wittenaar and Wesseling-Keuning, \{Gretha C\} and Jakob Hiddingh and Eshuis, \{Hans J\} and \{van der Schans\}, \{Cees P\} and Niemeijer, \{Anuschka S\} and Nieuwenhuis, \{Marianne K\}",

year = "2025",

month = aug,

day = "20",

doi = "10.1016/j.burns.2025.107673",

language = "English",

volume = "51",

journal = "Burns : journal of the International Society for Burn Injuries",

issn = "0305-4179",

publisher = "Elsevier Limited",

number = "8",

}

Bosch, FG, Jager-Wittenaar, H, Wesseling-Keuning, GC, Hiddingh, J, Eshuis, HJ, van der Schans, CP, Niemeijer, AS & Nieuwenhuis, MK 2025, 'Feasibility, reliability, and clinical utility of skeletal muscle assessment with A-mode ultrasonography in hospitalized patients with burns', Burns : journal of the International Society for Burn Injuries, vol. 51, no. 8, 107673. https://doi.org/10.1016/j.burns.2025.107673

Feasibility, reliability, and clinical utility of skeletal muscle assessment with A-mode ultrasonography in hospitalized patients with burns. / Bosch, Frederiek G; Jager-Wittenaar, Harriët; Wesseling-Keuning, Gretha C et al.
In: Burns : journal of the International Society for Burn Injuries, Vol. 51, No. 8, 107673, 20.08.2025.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Feasibility, reliability, and clinical utility of skeletal muscle assessment with A-mode ultrasonography in hospitalized patients with burns

AU - Bosch, Frederiek G

AU - Jager-Wittenaar, Harriët

AU - Wesseling-Keuning, Gretha C

AU - Hiddingh, Jakob

AU - Eshuis, Hans J

AU - van der Schans, Cees P

AU - Niemeijer, Anuschka S

AU - Nieuwenhuis, Marianne K

PY - 2025/8/20

Y1 - 2025/8/20

N2 - OBJECTIVES: Amplitude-mode (A-mode) ultrasonography is a promising technique to monitor loss and recovery of skeletal muscle in patients with burns. However, its clinimetric properties are unknown. Therefore, we determined its feasibility, interrater, and intrarater reliability, and clinical utility.METHODS: Skeletal muscle thickness of upper arms and legs was assessed longitudinally in hospitalized adult patients with ≥ 5 % total body surface area (TBSA) burns, by pairs of two out of five raters. Feasibility was evaluated by % successful assessments, reliability by intra-class correlation coefficients (ICCs), and clinical utility by smallest detectable change (SDC).RESULTS: Thirty-four patients participated (77 % male; mean age 48 ± 17 y, median TBSA burned 12 % [IQR 7-19]). Images were acquired on 69 % of planned occasions, and 89 % of images could be analyzed. Overall interrater ICCs were ≥ 0.84 (for pairs: 0.63-0.99) and intrarater ICCs were ≥ 0.95 (for pairs: 0.45-0.99). The overall interrater SDC was ≤ 33 % of the measured mean (for pairs: 3-52 %), while intrarater SDC was ≤ 20 % (for pairs: 3-48 %). All five raters could measure legs with moderate to excellent reliability, whereas for arms some demonstrated poor reliability.CONCLUSION: A-mode ultrasonography assessment of skeletal muscle in patients with burns is feasible. However, reliability and clinical utility are rater-dependent; therefore we recommend assessments by the same rater.

AB - OBJECTIVES: Amplitude-mode (A-mode) ultrasonography is a promising technique to monitor loss and recovery of skeletal muscle in patients with burns. However, its clinimetric properties are unknown. Therefore, we determined its feasibility, interrater, and intrarater reliability, and clinical utility.METHODS: Skeletal muscle thickness of upper arms and legs was assessed longitudinally in hospitalized adult patients with ≥ 5 % total body surface area (TBSA) burns, by pairs of two out of five raters. Feasibility was evaluated by % successful assessments, reliability by intra-class correlation coefficients (ICCs), and clinical utility by smallest detectable change (SDC).RESULTS: Thirty-four patients participated (77 % male; mean age 48 ± 17 y, median TBSA burned 12 % [IQR 7-19]). Images were acquired on 69 % of planned occasions, and 89 % of images could be analyzed. Overall interrater ICCs were ≥ 0.84 (for pairs: 0.63-0.99) and intrarater ICCs were ≥ 0.95 (for pairs: 0.45-0.99). The overall interrater SDC was ≤ 33 % of the measured mean (for pairs: 3-52 %), while intrarater SDC was ≤ 20 % (for pairs: 3-48 %). All five raters could measure legs with moderate to excellent reliability, whereas for arms some demonstrated poor reliability.CONCLUSION: A-mode ultrasonography assessment of skeletal muscle in patients with burns is feasible. However, reliability and clinical utility are rater-dependent; therefore we recommend assessments by the same rater.

KW - Bedside ultrasonography

KW - Catabolism

KW - Muscle wasting

KW - Skeletal muscle mass

KW - burns

KW - brandwonden

KW - echografie aan het bed

KW - katabolisme

KW - skeletspiermassa

KW - spierverspilling

U2 - 10.1016/j.burns.2025.107673

DO - 10.1016/j.burns.2025.107673

M3 - Article

C2 - 40885106

SN - 0305-4179

VL - 51

JO - Burns : journal of the International Society for Burn Injuries

JF - Burns : journal of the International Society for Burn Injuries

IS - 8

M1 - 107673

ER -

Bosch FG, Jager-Wittenaar H, Wesseling-Keuning GC, Hiddingh J, Eshuis HJ, van der Schans CP et al. Feasibility, reliability, and clinical utility of skeletal muscle assessment with A-mode ultrasonography in hospitalized patients with burns. Burns : journal of the International Society for Burn Injuries. 2025 Aug 20;51(8):107673. Epub 2025 Aug 19. doi: 10.1016/j.burns.2025.107673

Feasibility, reliability, and clinical utility of skeletal muscle assessment with A-mode ultrasonography in hospitalized patients with burns

Abstract

UN SDGs

Keywords

Research Focus Areas Hanze University of Applied Sciences * (mandatory by Hanze)

Research Focus Areas Research Centre or Centre of Expertise * (mandatory by Hanze)

Publinova themes

Access to Document

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Cite this