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

Apr 2, 2025Nursing in critical care

Best score threshold of the Chelsea Physical Assessment Tool to identify weakness in ventilated intensive care patients

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Abstract

The optimal cut-off point for the Chelsea Critical Care Physical Assessment Tool (CPAx) to diagnose ICU-acquired weakness is 31.

The area under the curve (AUC) for CPAx was 0.87 at baseline, 0.96 at weaning, and 0.91 at discharge, indicating strong diagnostic performance.
The maximum value of the Youden Index (YI) for CPAx was 0.62 at baseline, 0.91 at weaning, and 0.65 at discharge.
At a cut-off score of 31.5, CPAx demonstrated a sensitivity of 95% and specificity of 90% for diagnosing ICU-AW during weaning.
At discharge, a CPAx score of 31.5 showed a sensitivity of 94% and specificity of 71% for ICU-AW diagnosis.
The CPAx score of 31 was preliminarily identified as the threshold for diagnosing ICU-AW, aligning with the Medical Research Council Sum Scale (MRC-ss) criteria.

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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). The kappa (κ) test was used to test the consistency of the MRC-ss and CPAx. max

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.

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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

Abstract

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