Inter‐rater reliability of three most commonly used pressure ulcer risk assessment scales in clinical practice

The objective of this study was to evaluate inter‐rater reliability of Braden Scale, Norton Scale and Waterlow Scale for pressure ulcer risk assessment in clinical practice. The design of the study was cross‐sectional. A total of 23 patients at pressure ulcer risk were included in the study, and 6 best registered nurses conducted three subsequent risk assessments for all included patients. They assessed alone and independently from each other. An intra‐class correlation coefficient (ICC) was used to determine the inter‐rater reliability. For the Braden Scale, the ICC values ranged between 0·603 (95% CI: 0·435–0·770) for the item ‘moisture’ and a maximum of 0·964 (95% CI: 0·936–0·982) for the item ‘activity’; for the Norton Scale, the ICC values ranged between 0·595 (95% CI: 0·426–0·764) for the item ‘physical condition’ and a maximum of 0·975 (95% CI: 0·955–0·988) for the item ‘activity’; and for the Waterlow Scale, the ICC values ranged between 0·592 (95% CI: 0·422–0·762) for the item ‘skin type’ and a maximum of 0·990 (95% CI: 0·982–0·995) for the item ‘activity’. The ICC values of total score for three scales of were 0·955 (95% CI: 0·922–0·978), 0·967 (95% CI: 0·943–0·984), and 0·915 (95% CI: 0·855–0·958) for Braden, Norton, and Waterlow scales, respectively. Although the inter‐rater reliability of Braden Scale, Norton Scale and Waterlow Scale total scores were all substantial, the reliability of some items was not so good. The items of ‘moisture’, ‘physical condition’ and ‘skin type’ should be paid more attention. However, some studies are needed to find out high reliable quantitative items to replace these ambiguous items in new designed scales.     

Penetrating craniocerebral missile injuries in civilians: A retrospective analysis of 314 cases

Analysis of 314 cases of penetrating craniocerebral missile injuries in civilians revealed a high rate of early mortality, with 228 victims having died at the scene and a further 38 dead within 3 hours. Surgery was performed in 44 patients who had a preoperative Glasgow Coma Score of at least 4. Out of the 26 survivors, all operated upon, 19 had an adequate recovery (score of 0–3 on the expanded Glasgow Outcome Scale). Vigorous resuscitation and early surgery often resulted in useful survivals and occasionally in spectacular recoveries. However, the high mortality rate on the scene or soon after the injury restricted the possibility of effective management to a minority of cases.     

Psychometric properties of selected tests in patients with lumbar spinal stenosis

Background context

The psychometric properties of many outcome tools commonly used with patients with lumbar spinal stenosis have yet to be examined.

Purpose

Examine the test-retest reliability, responsiveness, and minimum levels of detectable and clinically important differences for several outcome measures in a cohort of patients with lumbar spinal stenosis.

Study design/setting

Cohort secondary analysis of a randomized clinical trial of patients with lumbar spinal stenosis receiving outpatient physical therapy.

Patient sample

Fifty-five patients (mean age, 69.5 years; standard deviation, ±7.9 years; 43.1% females) presenting with lumbar spinal stenosis to physical therapy.

Outcome measures

The Modified Oswestry Disability Index, Modified Swiss Spinal Stenosis Scale (SSS), Patient Specific Functional Scale, and Numeric Pain Rating Scale (NPRS).

Methods

All patients completed the Oswestry Disability Index, SSS, Patient Specific Functional Scale, and NPRS at the baseline examination and at a follow-up. In addition, patients completed a 15-point Global Rating of Change at follow-up, which was used to categorize whether patients experienced clinically meaningful change. Changes in the Oswestry Disability Index, SSS, Patient Specific Functional Scale, and NPRS were then used to assess test-retest reliability, responsiveness, and minimum levels of detectable and clinically important differences.

Results

The Oswestry Disability Index was the only outcome measure to exhibit excellent test-retest reliability with an intraclass correlation coefficient of 0.86 (95% confidence interval, 0.63–0.93). All others ranged between fair and moderate. The Oswestry Disability Index, SSS, and Patient Specific Functional Scale exhibited varying levels of responsiveness, each of which was superior to the NPRS. The minimal clinically important difference for the Oswestry Disability Index was five points, the SSS was 0.36 and 0.10 for symptoms subscale and functional subscale, respectively, 1.3 for the Patient Specific Functional Scale, and for the NPRS, 1.25 for back/buttock symptoms and 1.5 for thigh/leg symptoms.

Conclusions

The results of our study indicate that the Oswestry Disability Index, SSS, and Patient Specific Functional Scale possess adequate psychometric properties to be used in the outcome assessment of patients with lumbar spinal stenosis. However, further investigation is needed to validate these findings in other samples of patients with lumbar spinal stenosis and nonspecific low back pain.     

Translation and psychometric evaluation of Persian versions of Burn Specific Pain Anxiety Scale and Impact of Event Scale

Background

Burn as a traumatic life incident manifests severe pain and psychological problems. Specific instruments are needed to evaluate burn patients’ psychological issues related to the injury. The aim of this study was to translate and evaluate the reliability and validity of the Persian versions of Impact of Burn Specific Pain Anxiety scale (BSPAS) and Impact of Event Scale (IES).

Methods

In this cross-sectional study, convenience sampling method was utilized to select 55 Iranian hospitalized burn patients. Combined translation was utilized for translating scales. Alpha cronbach, item-total correlation, convergent and discriminative validity were evaluated.

Results

The Cronbach's α for both BSPAS- and IES-Persian version was 0.96. Item-total correlation coefficients ranged from 0.70 to 0.90. Convergent construct validity was confirmed by indicating high correlation between the scales designed to measure the same concepts. The mean score of BSPAS- and IES-Persian version was lower for individuals with a lower TBSA burn percentage which assessed discriminative construct validity of scales.

Conclusions

BSPAS- and IES-Persian version showed high internal consistency and good validity for the assessment of burn psychological outcome in hospitalized burn patients. Future studies are needed to determine repeatability, factor structure, sensitivity and specificity of the scales.     

Evaluating postherniorrhaphy groin pain: Visual Analogue or Verbal Rating Scale?

Introduction Several tools for pain measurement including a Visual Analogue Scale (VAS) and a Verbal Rating Scale (VRS) are currently used in patients with chronic pain. The aim of the present study was to determine which of these two pain tests performs optimally in patients following groin hernia repair. Patients and methods A questionnaire identified pain level in a cohort of patients that had previously undergone corrective groin hernia surgery. Current pain intensity was graded on a four-point VRS scale (no pain, mild, moderate or severe pain) and on a 100-mm VAS scale (0 = no pain, 100 = unbearable). “Scale failure” (one or both tests not completed correctly) was determined, and cut-off points for the VAS test were calculated by creating the optimum kappa coefficient between both tools. Results The response rate was 78.2% (706/903). Scale failure was present in VAS tests more than VRS (VAS: 12.5%, 88/706 vs. VRS: 2.8%, 20/706; P < 0.001). Advanced age was a risk factor for scale failure (P < 0.001). The four categories of VRS corresponded to mean VAS scores of 1, 20, 42, and 78 mm, respectively. VAS categories associated with the highest kappa coefficient (k = 0.78) were as follows: 0–8 = no pain, 9–32 = mild, 33–71 = moderate, >71 = severe pain. VAS scores grouped per VRS category showed considerable overlap. Age and sex did not significantly influence cut-off points. Conclusions Because of lower scale failure rates and overlapping VAS scores per VRS category, the VRS should be favored over the VAS in future postherniorrhaphy pain assessment. If VAS is preferred, the presented cut-off points should be utilized. This study was unfunded.     

Glasgow Coma Scale, brain electric activity mapping and Glasgow Outcome Scale after hyperbaric oxygen treatment of severe brain injury

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Comparing Quantification of Pain Severity by Verbal Rating and Numeric Rating Scales

Background:

Researchers have reported widely varying correlations among the 3 main instruments used to quantify pain severity, Visual Analog Scale (VAS), Verbal Rating Scale (VRS), and Numeric Rating Scale (NRS), both at the level of groups and at the level of individuals.

Objective:

To assess the comparability of reports of pain severity using a VRS and a NRS in a spinal cord injury (SCI) sample.

Methods:

Data were taken from a longitudinal observational study. Patients were 168 individuals with new traumatic SCI admitted for inpatient rehabilitation who completed the VRS and NRS multiple times, each time for multiple pains as appropriate.

Results:

For 1,114 ratings of pain, VRS and corresponding NRS ratings were correlated weakly (Spearman correlation, rho  =  0.38). For 36 individuals with at least 10 completions of paired VRS and NRS, rho ranged from −0.55 to 0.76. Variation in NRS rating for each VRS adjective was reduced by about 25% when between-patient variation was eliminated. Mean NRS ratings by VRS adjective, for patients who had used each of at least 2 adjectives at least 5 times each, showed large differences in mean NRS scores between individuals using the same VRS adjective.

Conclusion:

There are considerable differences between individuals in how NRS and VRS are used; there also seem to be individuals whose understanding of the meaning of the VRS adjectives is completely different from what was assumed by the creators of this VRS. Both VRS and NRS data must be used with extreme caution by SCI clinicians and researchers.     

The revised civilian mississippi scale for PTSD: Reliability,validity, and cross-language stability

Examined in two studies the psychometric properties of a revised 30-item version of the civilian form of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder (PTSD) developed by Keane, Caddell, and Taylor (1988). Study 1, whose sample was composed of 37 bilingual adults who had experienced a variety of traumatic events, was undertaken primarily to examine the linguistic equivalence of a Spanish translation of the scale. High cross-language stability was demonstrated, and both English and Spanish versions showed high internal consistency. Study 2, which used a sample of 404 victims of Hurricane Andrew, provided additional evidence of scale reliability and also showed that the scale correlates in meaningful ways with known traumatic stressors. Together the results indicate that the scale is applicable to different populations and events and constitutes a valid and reliable self-report measure of PTSD.     

Comparing Quantification of Pain Severity by Verbal Rating and Numeric Rating Scales

Abstract

Background: Researchers have reported widely varying correlations among the 3 main instruments used to quantify pain severity, Visual Analog Scale (VAS), Verbal Rating Scale (VRS), and Numeric Rating Scale (NRS), both at the level of groups and at the level of individuals.

Objective: To assess the comparability of reports of pain severity using a VRS and a NRS in a spinal cord injury (SCI) sample.

Methods: Data were taken from a longitudinal observational study. Patients were 168 individuals with new traumatic SCI admitted for inpatient rehabilitation who completed the VRS and NRS multiple times, each time for multiple pains as appropriate.

Results: For 1,114 ratings of pain, VRS and corresponding NRS ratings were correlated weakly (Spearman correlation, rho = 0.38). For 36 individuals with at least 10 completions of paired VRS and NRS, rho ranged from -0.55 to 0.76. Variation in NRS rating for each VRS adjective was reduced by about 25% when between-patient variation was eliminated. Mean NRS ratings by VRS adjective, for patients who had used each of at least 2 adjectives at least 5 times each, showed large differences in mean NRS scores between individuals using the same VRS adjective.

Conclusion: There are considerable differences between individuals in how NRS and VRS are used; there also seem to be individuals whose understanding of the meaning of the VRS adjectives is completely different from what was assumed by the creators of this VRS. Both VRS and NRS data must be used with extreme caution by SCI clinicians and researchers.     

Use of the bispectral index during the early postresuscitative phase after out-of-hospital cardiac arrest

Non-invasive and real-time measures of neurological status after cardiac arrest are needed to be able to make an early determination of the postresuscitative outcome. We investigated whether the bispectral index (BIS) predicts the postresuscitative outcome in 10 patients with out-of-hospital cardiac arrest. We measured the BIS after return of spontaneous circulation (ROSC) in the emergency room and on admission to the intensive care unit (ICU). We determined the Glasgow Coma Scale (GCS) on admission to the emergency room and the ICU and the Glasgow Outcome Scale (GOS) on discharge from the ICU. The BIS increased after about 30 min of ROSC or reached a plateau in patients rated as achieving a good recovery or moderate disability, but it did not increase to >80 in patients rated as being in a permanent vegetative state/dead. The GCS on admission to the ICU was the same as that on admission to the emergency room. The BIS values were significantly lower in the nonsurviving group than in the surviving group. There was a positive correlation between the BIS on admission to the ICU and the GOS on discharge from the ICU. The BIS can thus be used to predict the postresuscitative outcome of patients with out-of-hospital cardiac arrest.     

Psychometric Properties of the Civilian Version of the Mississippi PTSD Scale

The psychometric properties of the Civilian Mississippi Posttraumatic Stress Disorder (PTSD) Scale were explored. The Mississippi is internally consistent ( .89, split-half r .80), and it can discriminate between traumatized and nontraumatized respondents. However, its relationship with measures of PTSD was weaker than its relationship with measures of depression and anxiety, suggesting that it may be more of a general measure of distress. The results of a series confirmatory factor analyses provided mixed results. These findings were discussed along with recommendations for use of this instrument.     

Clinical and radiological factors predicting recurrence of chronic subdural hematoma: A retrospective cohort study

BackgroundChronic subdural hematoma (CSDH) is commonly encountered in the elderly patients and the recurrence rate is still high, therefore, identifying risk factors for CSDH recurrence is essential. The present study aimed to identify clinical and radiological factors predicting the recurrence of CSDH.MethodsWe retrospectively identified 461 patients with CSDH who underwent surgical evacuation in our department. Univariable analyses were performed at first, variables with a P-value of <0.05 were entered into multivariable logistic regression model. Kendall's tau-b test was used to evaluate the relationship between brain atrophy and postoperative pneumocephalus.ResultsUnivariable analyses revealed that patients with the following characteristics have a higher recurrence rate, including age ≥80 years, antiplatelet and/or anticoagulant use, GOS = 3, the volume of drainage ≥100 ml, midline shift ≥10 mm, severe brain atrophy, severe postoperative pneumocephalus. Multivariable logistic regression demonstrated that midline shift ≥10 mm, severe brain atrophy, severe postoperative pneumocephalus, and volume of drainage ≥100 ml were independent risk factors for CSDH recurrence. Kendall's tau-b test revealed that there was no correlation between brain atrophy and postoperative pneumocephalus.ConclusionsMidline shift ≥10 mm, severe brain atrophy, severe postoperative pneumocephalus, and volume of drainage ≥100 ml were independent risk factors for CSDH recurrence, CSDH patients with these characteristics should be taken precautions of recurrence and a closely follow-up should be carried out.     

Emergency neurosurgery by general surgeons at a remote major hospital

BACKGROUND: Due to the geographical remoteness of Darwin, which has no resident neurosurgeon, emergency transfer of patients for neurosurgery is usually impractical. In Darwin emergency neurosurgery must be undertaken by general surgeons. METHODS: Data from the operating theatre, Emergency Department and Intensive Care Unit were prospectively recorded on all patients who underwent an emergency neurosurgical procedure between January 1992 and June 2004. Outcomes were assessed by retrospective case note review. RESULTS: Three hundred and five neurosurgical procedures were performed upon 258 patients (average 26.5 procedures per year), including 130 craniotomies, 88 burr holes, 3 posterior fossa craniotomies, 2 decompressive frontal lobectomies, 4 decompressive craniectomies, 25 elevations of fracture and 33 ventricular drains only. Assault/domestic incident (31%) was a more common aetiology than motor vehicle accidents (29%). Outcome was best for extradural haematoma (82% good/moderate) and chronic subdural haematoma (84% good/moderate). In contrast, 44% with acute subdural haematoma and 77% with intracerebral haematoma died. Irrespective of type of bleed, Glasgow Coma Scale (GCS) score at presentation was a reliable predictor of outcome following surgery (61% correlation): 60% with GCS less than 9 died whereas 79% with GCS over 11 had a good recovery. Acute Physiology And Chronic Health Evaluation, version 2 and Simplified Acute Physiology Score, version 2 scores were also independent predictors of outcome. Time from presentation to operation for extradural haematoma and acute subdural haematoma was prolonged (more than 4 h) in 48% and was associated with worse outcome (P = 0.0001). Neither extremes of age nor the particular surgeon performing the operation affected outcome. CONCLUSIONS: General surgeons undertake a substantial number of procedures across a broad spectrum of emergency neurosurgery in Darwin. Outcomes following surgery appear acceptable.     

Correlation between Braden Scale and Palliative Performance Scale in advanced illness

This study describes the significant correlation between the Braden Scale (BS) and the Palliative Performance Scale (PPS) in patients with advanced illness that has not been previously reported. The analysis was based on a prospective sequential case series of 664 patients suffering from advanced illness who were referred to a regional palliative medicine programme in Toronto, Canada. Baseline BS and PPS scores assessed within 24 hours of referral were considered for analysis. After controlling for age, gender, consult site and diagnosis (cancer versus non cancer), we observed a significant positive correlation between baseline PPS and BS scores (r = 0·885, P < 0·001). These findings suggest that for patients with advanced illness where BS is not routinely used, PPS could be considered as a proxy for pressure ulcer risk assessment.     

医学美学对骨科手术后康复和患者满意度的影响

为评估医学美学对接受骨科手术后的康复过程和患者满意度的影响，本研究选取2019年 2月-2022年1月在唐山弘慈医院骨科病区住院并接受骨科手术的142例患者作为研究对象，采用医学审美满 意度量表（MASS）评估患者对审美结果的满意度、骨科康复进展量表（ORPS）评估患者康复进展，探讨 MASS和ORPS评分间的关系，并应用多变量线性回归分析康复进展和患者满意度的预测因素。该研究结 果显示，较高的审美满意度得分与较快的康复进展之间存在正相关，说明医学美学在骨科手术后的康复过 程和患者的整体满意度中的重要作用。     

抗抑郁剂治疗手术后胃瘫综合征31例临床分析

目的：探讨精神、心理因素与手术后胃瘫综合征的关系及抗抑郁剂对其的疗效。方法：对31例正常人和31例手术后胃瘫综合征患者进行汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）和症状自评量表（SCL-90）评分;31例手术后胃瘫综合征患者用5-羟色胺再摄取抑制剂（SSRI）西酞普兰治疗,疗程均为8周,治疗后再行量表评分。结果：3种量表（HAMD、HAMA、SCL-90）评分结果,均显示手术后胃瘫综合征患者的精神、躯体症状与正常人之间差异有非常显著性（P〈0.01）;手术后胃瘫综合征患者接受抗抑郁剂治疗8周后,精神和躯体症状均有明显改善。结论：手术后胃瘫综合征与精神心理因素相关,患者普遍存在抑郁和焦虑情绪,用抗抑郁剂治疗能显著改善精神和躯体两方面症状。     

均匀性脂肪肝简易分度法探讨

目的探讨一种简单易行的均匀性脂肪肝的分度方法。方法对45例脂肪肝患者进行超声检查,其中轻度组16例,中度组20例,重度组9例,观察其肝后场衰减程度、肝前场门静脉管壁清晰度及肝实质点状回声强度。同时检查血脂及肝功能等生化指标。将上述指标分别量化、计分,计算轻、中、重度组每个病例的综合积分,从而推断不同程度脂肪肝的综合积分值。结果轻、中、重度脂肪肝三组间的综合积分值差异有显著的统计学意义（P=0.000）。轻、中、重度脂肪肝三组综合积分值逐渐增加,并且两两比较均有统计学意义（P=0.001,P=0.000,P=0.001）。结论综合积分分度法可能是判断均匀性脂肪肝病变程度的一种简易可行的方法。     

Traumatische Hirnstammläsionen im Kindesalter

Zusammenfassung Grundlagen: Zahlreiche Studien unterstreichen die Aussagekraft der initialen Glasgow Coma Scale (GCS) nach einem Sch?del-Hirntrauma für den weiteren klinischen Verlauf. Ziel dieser retrospektiven Studie war es, prognostische Faktoren für den klinischen Ausgang von Kindern mit traumatischen Hirnstamml?sionen zu ermitteln. Methodik: Insgesamt wurden in den letzten 16 Jahren 1108 Kinder mit einem Sch?del-Hirntrauma untersucht, wovon 23 Patienten klinische und/oder radiologische Zeichen einer Hirnstamml?sion aufwiesen. Die initiale neurologische Beurteilung erfolgte durch Bewertung mit dem GCS. Unsere Studie verglich den initialen GCS mit dem klinischen Verlauf unter Zuhilfenahme der Glasgow Outcome Scale (GOS). Ergebnisse: Bei 13 Patienten (57%) waren neben der Hirnstammsymptomatik entsprechende morphologische L?sionen in der CT bzw. MRI erkennbar. 7 Patienten (30%) wiesen nur klinische Zeichen einer Hirnstammaffektion auf, w?hrend 3 Patienten (13%) eindeutig morphologische L?sionen ohne entsprechendes klinisches Korrelat zeigten. Patienten mit einem GCS von 3 bis 4 Punkten (n = 15) zeigten einen signifikanten Unterschied (p < 0,001) im Langzeitverlauf (GOS) gegenüber jenen Patienten (n = 8) mit einem initialen GCS von 5 bis 7 Punkten. Schlu?folgerungen: Die Ergebnisse lassen einen direkten Zusammenhang zwischen Ausgang und initialem klinischem Befund erkennen, jedoch keinen mit dem im CT verifizierten Befund. Hinsichtlich der Hirnstamml?sionen erwies sich das MRI als die sensitivere Methode.      

The evolution and utility of the burn specific health scale: A systematic review

The Burn Specific Health Scale (BSHS) is the most commonly used instrument used to evaluate burn survivors’ quality of life (QOL). Multiple forms of the instrument exist; however, the literature lacks clarity in regard as to why a particular version of the BSHS was used and how the instrument performed in a variety of samples. This paper provides a review of the literature of the variations of the BSHS, its utility for research and clinical practice, and scoring concerns.     

Reliability and validity of a brief instrument for assessing post-traumatic stress disorder

This study examines the psychometric properties of two versions of the PTSD Sympton Scale (PSS). The scale contains 17 items that diagnose PTSD according to DSM-III-R criteria and assess the severity of PTSD symptoms. An interview and self-report version of the PSS were administered to a sample of 118 recent rape and non-sexual assault victims. The results indicate that both versions of the PSS have satisfactory internal consistency, high test-retest reliability, and good concurrent validity. The interview version yielded high interrater agreement when administred separately by two interviewers and excellent convergent validity with the SCID. When used to diagnose PTSD, the self-report version of the PSS was somewhat more conservative than the interview version.