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While there is no universal gold standard for ultrasound-based sarcopenia assessment, biceps brachii and rectus femoris are among the most commonly used and validated muscles for this purpose. In our study, though, we had a limited number of outcome events, in which only 37 patients experienced a fall. [...]our ability to adjust for many covariates was limited by standard statistical methods. Fear of falling has been shown in other research to be independently associated with actual fall risk, and it may reflect underlying physiological changes that aren't always fully assessed by strength tests or imaging [ 5].

Falls are a significant issue among older adults, leading to morbidity and mortality. Screening for fall risk in the ED is crucial but challenging due to time limitations and patient conditions. Sarcopenia, characterized by muscle loss, is associated with increased fall risk, and ultrasound has been proposed as a non-invasive tool to measure muscle mass in this context. This prospective cohort study enrolled 174 older adults from an urban teaching hospital's EDOU, assessing muscle mass via POCUS, grip strength, Timed Up and Go (TUG) test, and fall risk using the STEADI toolkit. The patients were followed up over six months to assess if they had fallen or not. Follow-up identified 37 participants (21 %) as patients who fell. There was no significant association between POCUS-measured muscle mass, grip strength, or TUG test performance with future falls. In contrast, STEADI questionnaire responses demonstrated significant differences between patients who fell and did not fall, suggesting its potential utility in predicting fall risk in this population. The simpler tool, the STEADI questionnaire, may offer more practicality in screening fall risk compared to complex ultrasound measurements or physical performance tests among the older in ED.

The importance of this study is to devise an efficient tool for assessing frailty in the ED. The goals of this study are 1) to correlate ultrasonographic (US) measurements of muscle thickness in older ED patients with frailty and 2) to correlate US-measured sarcopenia with falls, subsequent hospitalizations and ED revisits. Participants were conveniently sampled from a single ED in this prospective cohort pilot study of patients aged 65 or older. Participants completed a Fatigue, Resistance, Ambulation, Illness and Loss of Weight (FRAIL) scale assessment and US measurements of their upper arm muscles, quadricep muscles, and abdominal wall muscles thickness. We conducted one-month follow-up phone calls to assess for falls, ED revisits, and subsequent hospital visits. We enrolled 43 patients (mean age of 78.5). Ultrasound measurements of the three muscle groups were not significantly different between frail and non-frail groups. Frail participants had greater bicep asymmetry (a difference of 0.47 cm vs 0.24 cm, p < .01). A predictive logistic regression model using average quadriceps thickness and biceps asymmetry was found to identify frail patients (AUC of 0.816). Participants with subsequent falls had smaller quadriceps (1.18 cm smaller, p < .01). Subsequently hospitalized patients were found to have smaller quadriceps muscles (0.54 cm smaller, p = .03) and abdominal wall muscles (0.25 cm smaller, p = .01). US measurements of sarcopenia in older patients had mild to moderate associations with frailty, falls and subsequent hospitalizations. Further investigation is needed to confirm these findings.

AbstractObjectiveTo characterize the national distribution of COVID‐19 hospital and emergency department visitor restriction policies across the United States, focusing on patients with cognitive or physical impairment or receiving end‐of‐life care. MethodsCross‐sectional study of visitor policies and exceptions, using a nationally representative random sample of EDs and hospitals during the first wave of the COVID‐19 pandemic, by trained study investigators using standardized instrument. ResultsOf the 352 hospitals studied, 326 (93%) had a COVID‐19 hospital‐wide visitor restriction policy and 164 (47%) also had an ED‐specific policy. Hospital‐wide policies were more prevalent at academic than non‐academic (96% vs 90%; P < 0.05) and at urban than rural sites (95% vs 84%; P < 0.001); however, the prevalence of ED‐specific policies did not significantly differ across these site characteristics. Geographic region was not associated with the prevalence of any visitor policies. Among all study sites, only 58% of hospitals reported exceptions for patients receiving end‐of‐life care, 39% for persons with cognitive impairment, and 33% for persons with physical impairment, and only 12% provided policies in non‐English languages. Sites with ED‐specific policies reported even fewer exceptions for patients with cognitive impairment (29%), with physical impairments (24%), or receiving end‐of‐life care (26%). ConclusionAlthough the benefits of visitor policies towards curbing COVID‐19 transmission had not been firmly established, such policies were widespread among US hospitals. Exceptions that permitted family or other caregivers for patients with cognitive or physical impairments or receiving end‐of‐life care were predominantly lacking, as were policies in non‐English languages.