ICU sedation, delirium & recovery
Construct validity and inter- rater reliability of the Heckmatt scale for assessing muscle quality in critically ill patients
Authors' conclusion
The Heckmatt scale shows acceptable measurement properties for bedside assessment of muscle quality, particularly in larger muscles during early ICU stay.
Study context
- Population
- Critically ill patients undergoing peripheral muscle ultrasound (quadriceps: rectus femoris, vastus intermedius; tibialis anterior) on days 1, 3 and 7
- Comparison
- Heckmatt scale scores vs grayscale echogenicity; agreement between 3 evaluators
- Outcome
- Construct validity (Spearman correlation of Heckmatt scores with echogenicity) and inter-rater reliability (ICC(1, 2)) of the Heckmatt scale
- Follow-up
- Days 1, 3, and 7
Methodological detailsblinded evaluators
- Blinded evaluators
Main finding
As reported in the abstract
Construct validity and inter-rater reliability
- Day 1: correlation strong for rectus femoris (rho, p < 0.001)
- 0.74
- Day 1: correlation moderate for vastus intermedius and tibialis anterior (rho, p < 0.001)
- 0.47-0.48
- Day 7: correlation strong to very strong in quadriceps (rho, p < 0.001)
- 0.61-0.84
- Day 7: correlation moderate in tibialis anterior (rho, p = 0.01)
- 0.36
- Reliability moderate to good on days 1-3 (ICC range)
- 0.70-0.83
- Reliability decreased on day 7 (ICC range)
- 0.48-0.50
Original publication
Construct validity and inter- rater reliability of the Heckmatt scale for assessing muscle quality in critically ill patients. J Crit Care. Published 4 May 2026. doi:10.
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