3种压疮危险评估量表在神经外科ICU病人中的应用研究

[目的]研究Braden量表、Norton量表和Waterlow压疮危险评估量表在神经外科监护病房病人应用中的信效度情况。[方法]选择南通大学附属医院神经外科ICU入科前未发生压疮的病人121例,由两名研究者运用3种量表对病人发生压疮的风险进行评估,连续评估病人发生压疮的危险,采用Cronbach’sα系数评价量表的内部一致性信度、采用组内相关系数评价量表的评定者间的信度,采用灵敏度、特异度、ROC曲线下面积(AUC)评价量表的预测效度。[结果]Braden量表、Norton量表和Waterlow量表Cronbach’sα系数分别为0.459,0.397,0.311,ICC分别为0.79,0.89,0.78。Braden量表的AUC为0.365,高低危人群的分界诊断界值在10.5分时,灵敏度为36.4%,特异度为47.5%。Norton量表的AUC为0.475,高低危人群的分界诊断界值在10.5分时,灵敏度为59.1%,特异度为38.4%。Waterlow量表的AUC为0.468,高低危人群的分界诊断界值在20.5分时,灵敏度为54.5%,特异度为47.5%。[结论]Braden量表、Norton量表和Waterlow量表评定者间信度较好,内部一致性信度较差,与其他两个量表相比,Waterlow量表的预测效度较佳,提示进一步研究可对Waterlow量表的条目进行修订,研究更为准确且适合神经外科ICU病人的压疮预测工具。     

Braden压疮危险因素评估量表对基层医院危重病人的适用性研究

[目的]探讨Braden压疮危险因素评估量表对基层医院危重病人压疮评估的预测效力。[方法]采用日常活动能力分类量表、Braden压疮危险因素评估量表对74例危重病人如严重创伤、神经损伤、昏迷、死亡病人进行评估。[结果]日常活动能力分类量表评分3分～5分,Braden压疮危险因素评估量表6个条目平均分为2.36分～3.06分,压疮发生率为8.1%,Braden压疮危险因素评估量表临界值为14分时灵敏度为85.1%、特异度为93.2%、阳性预测值为33.4%、阴性预测值为98.7%。[结论]危重病人病情危重度越高,Braden压疮危险因素评估量表临界值取14分时其灵敏度和特异度较好;Braden压疮危险因素评估量表对我院危重病人的压疮预测效果较好。     

Braden压疮危险因素评估量表对基层医院危重病人的适用性研究

[目的]探讨Braden压疮危险因素评估量表对基层医院危重病人压疮评估的预测效力.[方法]采用日常活动能力分类量表、Braden压疮危险因素评估量表对74例危重病人如严重创伤、神经损伤、昏迷、死亡病人进行评估.[结果]日常活动能力分类量表评分3分～5分,Braden压疮危险因素评估量表6个条目平均分为2.36分～3.06分,压疮发生率为8.1%,Braden压疮危险因素评估量表临界值为14分时灵敏度为85.1%、特异度为93.2%、阳性预测值为33.4%、阴性预测值为98.7%.[结论]危重病人病情危重度越高,Braden压疮危险因素评估量表临界值取14分时其灵敏度和特异度较好;Braden压疮危险因素评估量表对我院危重病人的压疮预测效果较好.     

应用Braden量表联合近红外光谱仪评估ICU患者压疮发生的研究

目的探讨局部持续受压对组织血供的影响,评估患者压疮风险,为压疮早期监测提供依据。方法随机选取ICU住院患者117例,应用近红外光谱仪监测患者骶尾部组织氧饱和度,Braden量表进行压疮危险因素评估,采用灵敏度、特异度、阳性及阴性预测值和受试者工具特性曲线(ROC)评价近红外光谱仪对压疮的预测效果。结果有压疮者Braden评分为(12.23±1.67)分,未发生者为(13.14±1.48)分,差异有统计学意义(P0.05)。随ICU住院时间的延长,骶尾部组织氧饱和度(rSO2)持续下降。Braden评分评为中、高度压疮危险组,患者局部rSO2测量显著低于轻度压疮危险组;ROC曲线下面积显示,局部组织rSO2参数对压疮判断优于Braden量表评分,两者结合可提高压疮早期判断的有效性和可靠性。结论应用近红外光谱法结合Braden量表评估有利于临床早期压疮的监测。     

自制神经外科压疮危险因素评估量表与Braden量表信度与效度的比较研究

目的 更准确地评估神经外科患者发生压疮的危险性,降低压疮发生率.方法 采用两个评估量表(即自制神经外科压疮危险因素评估量表和Braden量表)评估500例神经外科患者的压疮危险因素,并进行信度和效度的比较.结果 自制神经外科压疮危险因素评估量表的Cronbach's α为0.941,Braden量表的Cronbach's α为0.743.因子分析结果显示,两个量表的结构效度与原设想的基本一致.预测效度显示,当自制神经外科压疮危险因素评估量表的诊断界值取16分时,灵敏度和特异度分别为89%和78%;当Braden量表取18分时,灵敏度和特异度分别为78%和58%.结论 两种量表均具有较好的内部一致性信度、结构效度和预测效度,但自制神经外科压疮危险因素评估量表优于Braden量表,是适合神经外科患者人群的压疮危险评估工具.     

Braden量表在足部压疮风险预测中的应用

目的评估Braden量表在足部压疮风险预测中的诊断价值。方法采用病例对照研究的方法,选择温州市某三级甲等医院124例臀部压疮患者和52例足部压疮患者作为压疮组,选取未发生任何部位压疮的患者120例作为对照组。应用Braden量表分别对两组患者进行诊断分析,通过灵敏度、特异度、ROC曲线等指标评价Braden量表在足部压疮风险预测中的诊断价值。结果臀部压疮组与足部压疮组患者的疾病诊断及压疮分期差异有统计学意义(P<0.01)。足部压疮组的平均Braden评分高于臀部压疮组,差异有统计学意义(P<0.05)。Braden量表预测臀部压疮的灵敏度为54.0%,ROC曲线下面积为0.756;预测足部压疮的灵敏度为40.4%,ROC曲线下面积为0.674。结论 Bra-den量表预测足部压疮风险尚存在不足。     

两种压疮危险因素评估量表在手术患者中信度和效度比较研究

目的比较两种压疮危险因素评估量表(Braden量表和修订版Braden量表)用于手术患者时的信度和效度,为降低术后患者压疮发生率提供有效的压疮危险因素评估工具。方法两名护士分别应用两种量表,同时、独立地对同一患者进行评估,共211例患者接受评估。结果两种量表的评估者间一致性信度Pearson相关系数分别为0.991、0.993;克朗巴赫系数α分别为0.518～0.743,0.307～0.551;Braden量表和修订版中分别去掉“营养状况”、“体型/身高状况”条目后量表的克朗巴赫系数α最高,分别为0.829、0.721;因子分析结果显示两种量表的结构效度与原设想的基本一致;当诊断界值取19分时,修订版Braden量表手术后当天评分的灵敏度和特异度相对较平衡,分别为70.0%、58.1%。结论两种量表具有较好的评估者间一致性信度、区分度和结构效度,在手术患者中的预测效度均不理想,但修订版优于Braden量表,适合中国手术患者人群的压疮危险因素评估工具有待进一步完善。     

两种评估表对脊柱后路手术患者压疮预测效果的比较研究

目的:研究脊柱外科脊柱后路手术患者的压疮发生率,比较Braden和Norton两种评估表对脊柱后路手术患者压疮的预测效果。方法:选取脊柱外科后路手术患者100例,运用两种评估表对其进行测评,在术后的0h、24h和72h分别观察和记录压疮的发生情况,计算各个量表的灵敏度和特异度。结果:压疮发生率为7%,该研究中的患者Braden评估表具有良好的灵敏度和特异性。结论:脊柱后路手术患者压疮的发生率较高,应用Braden评估表可以较好地预测压疮的发生。     

OH压疮评估表在老年患者压疮危险预测中的应用

目的:分析OH压疮评估表在住院老年患者中的压疮危险程度预测效果。方法:选择2016年5-11月南京市某三级甲等医院的住院患者为研究对象,由双人分别采用OH评估表和Braden量表对研究对象进行压疮危险评估,对最终收集到的286例资料完整者进行统计分析。结果:OH评估表的Spearman相关系数为0.995,其与Braden量表划分的压疮危险等级分布存在差异(P0.01);OH评分量表调查结果与压疮发生的符合率高于Braden评分量表,其ROC曲线下面积大于Braden评分(P0.05);护士使用OH评估表耗时短于Braden量表(P0.01)。结论:OH压疮评估表对老年患者压疮危险程度的预测能力优于Braden量表,在医院、家庭、社区及养老机构的老年患者中具有良好的推广前景。     

神经外科患者发生压疮的危险因素分析

目的 分析神经外科患者发生压疮的危险因素,为制定预防压疮有效措施提供依据.方法 收集神经外科有压疮发生危险的129例患者的一般资料及相关指标进行多元逐步Logistic同归分析,找出压疮发生的危险因素.结果 意识水平、活动能力、Braden得分是压疮发生的独立危险因素(P<0.05).结论 神经外科压疮预防应该更加关注意识、活动能力方面的评估,根据Braden量表评估结果进行有针对性的预防.     

Assessing predictive validity of the modified Braden scale for prediction of pressure ulcer risk of orthopaedic patients in an acute care setting

Aims and objectives. To assess and compare the predictive validity of the modified Braden and Braden scales and to identify which of the modified Braden subscales are predictive in assessing pressure ulcer risk among orthopaedic patients in an acute care setting. Background. Although the Braden scale has better predictive validity, literature has suggested that it can be used in conjunction with other pressure ulcer risk calculators or that some other subscales be added. To increase the predictive power of the Braden scale, a modified Braden scale by adding body build for height and skin type and excluding nutrition was developed. Design. A prospective cohort study. Method. A total of 197 subjects in a 106‐bed orthopaedic department of an acute care hospital in Hong Kong were assessed for their risk for pressure ulcer development by the modified Braden and Braden scales. Subsequently, daily skin assessment was performed to detect pressure ulcers. Cases were closed when pressure ulcers were detected. Results. Out of 197 subjects, 18 patients (9·1%) developed pressure ulcers. The area under the receiver operating characteristic curve for the modified Braden scale was 0·736 and for the Braden scale was 0·648. The modified Braden cut‐off score of 19 showed the best balance of sensitivity (89%) and specificity (62%). Sensory perception (Beta = ?1·544, OR=0·214, p = 0·016), body build for height (Beta = ?0·755, OR = 0·470, p = 0·030) and skin type (Beta = ?1·527, OR = 0·217, p = 0·002) were significantly predictive of pressure ulcer development. Conclusion. The modified Braden scale is more predictive of pressure ulcer development than the Braden scale. Relevance to clinical practice. The modified Braden scale can be adopted for predicting pressure ulcer development among orthopaedic patients in an acute care setting. Specific nursing interventions should be provided, with special attention paid to orthopaedic patients with impaired sensory perception, poor skin type and abnormal body build for height.     

Braden评估表在神经内科卧床患者压疮预防中的应用

目的 评价Braden评估表对神经内科卧床患者压疮的预测效果,探讨压疮分组预防措施效果.方法 选取400例新人院、首次评估无压疮的神经内科卧床患者,应用Braden评估表动态评估发生压疮的危险性,将400例患者按评分分为高危、中危、低危及无危组4组各100例,并分别将高危、中危、低危组随机分为实验组和对照组各50例;对照组采取常规干预措施,高危实验组使用气垫床,中危实验组使用海绵床垫,低危实验组每4 h翻身1次,其他预防措施同对照组,无危险组不采取任何干预措施.结果 Braden评估表在首次和末次评分时ROC曲线下面积分别为0.771和0.828,诊断界值取17分时其对应灵敏度、特异度、阳性预测值、阴性预测值等指标均能达到较高水平.在分组干预中,高、中、低危实验组分别与对照组比较,各组压疮发生率均无显著差异.结论 Braden评估表对神经内科卧床患者压疮发生有较好的预测效果,17分是较理想的诊断界值.对神经内科压疮高危者采用气挚床、中度危险者采用海绵垫,压疮发生率降低不显著.低危者可采取每4 h翻身1次的方法以减少资源的消耗.     

Braden评估表在神经内科卧床患者压疮预防中的应用

目的评价Braden评估表对神经内科卧床患者压疮的预测效果,探讨压疮分组预防措施效果。方法选取400例新人院、首次评估无压疮的神经内科卧床患者,应用Braden评估表动态评估发生压疮的危险性,将400例患者按评分分为高危、中危、低危及无危组4组各100例,并分别将高危、中危、低危组随机分为实验组和对照组各50例;对照组采取常规干预措施,高危实验组使用气垫床,中危实验组使用海绵床垫,低危实验组每4h翻身1次,其他预防措施同对照组,无危险组不采取任何干预措施。结果Braden评估表在首次和末次评分时ROC曲线下面积分别为0．771和0．828,诊断界值取17分时其对应灵敏度、特异度、阳性预测值、阴性预测值等指标均能达到较高水平。在分组干预中,高、中、低危实验组分别与对照组比较,各组压疮发生率均无显著差异。结论Braden评估表对神经内科卧床患者压疮发生有较好的预测效果,17分是较理想的诊断界值。对神经内科压疮高危者采用气垫床、中度危险者采用海绵垫,压疮发生率降低不显著。低危者可采取每4h翻身1次的方法以减少资源的消耗。     

手术患者压疮发生率及发生时间和影响因素研究

目的：探讨手术患者压疮发生率、发生时间特点和相关因素,为临床制定应对措施提供依据。方法：按照统一标准在12所综合医院中入选1074例术后患者,预防措施相同,采用“外科压疮风险评估表”收集每例患者术后0～5d基线资料,使用Braden计分量表评估压疮危险。采用Logistic回归分析压疮发生的影响因素。结果：观察期内1074例手术患者中发生11例11处Ⅰ期压疮,发生率1.02%,其中外科监护病房发生率1.95%。多发生在术后1～3d内。压疮发生的影响因素为：手术时间、术后皮肤水肿和使用矫形装置及Braden计分（P〈0.05）。结论：对手术时间≥2h、术后皮肤水肿、使用矫形装置及Braden计分≤16分的患者应作为术后压疮预防的重点对象,但Braden量表对围手术期患者压疮风险的预测作用尚有待于进一步研究。     

Incidence of pressure ulcers in a neurologic intensive care unit

OBJECTIVES: To determine the risk factors for pressure ulceration in an intensive care setting, to evaluate the Braden scale as a predictor of pressure ulcer risk in critically ill patients, and to determine whether pressure ulcers are likely to occur early in the hospital stay. DESIGN: Cohort study of patients with no preexisting ulcers with a 3-month enrollment period. SETTING: The neurologic intensive care unit and the neurologic intermediate unit at a primary care/referral hospital with a level I trauma center. PATIENTS: A total of 186 patients entered the study. INTERVENTION: Within 12 hrs of admittance, initial assessment, photographs, and Braden score were completed. Patients were re-examined every 4 days or at discharge from the unit, whichever came first. MAIN OUTCOME MEASURES: Determining risk factors for pressure ulcers, performing detailed statistical analyses, and testing the usefulness of the Braden score as a predictor of pressure ulcer risk. RESULTS: Twenty-three of 186 patients developed at least one pressure ulcer (incidence = 12.4%) after an average stay of 6.4 days. The Braden scale, which measures six characteristics of skin condition and patient status, proved to be a primary predictor of ulcer development. No ulcers developed in the 69 patients whose Braden score was 16 or higher. The likelihood of developing a pressure sore was predicted mathematically from the Braden score. However, being underweight was a significant and distinct factor in pressure ulcer development. CONCLUSIONS: Pressure ulcers may develop within the first week of hospitalization in the intensive care unit. Patients at risk have Braden scores of < or = 16 and are more likely to be underweight. These results suggest that aggressive preventive care should be focused on those patients with Braden scores of < or = 13 and/or a low body mass index at admission.     

Risk assessment scales for pressure ulcer prevention: a systematic review

AIM: This paper reports a systematic review conducted to determine the effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice, degree of validation of risk assessment scales, and effectiveness of risk assessment scales as indicators of risk of developing a pressure ulcer. BACKGROUND: Pressure ulcers are an important health problem. The best strategy to avoid them is prevention. There are several risk assessment scales for pressure ulcer prevention which complement nurses' clinical judgement. However, some of these have not undergone proper validation. METHOD: A systematic bibliographical review was conducted, based on a search of 14 databases in four languages using the keywords pressure ulcer or pressure sore or decubitus ulcer and risk assessment. Reports of clinical trials or prospective studies of validation were included in the review. FINDINGS: Thirty-three studies were included in the review, three on clinical effectiveness and the rest on scale validation. There is no decrease in pressure ulcer incidence was found which might be attributed to use of an assessment scale. However, the use of scales increases the intensity and effectiveness of prevention interventions. The Braden Scale shows optimal validation and the best sensitivity/specificity balance (57.1%/67.5%, respectively); its score is a good pressure ulcer risk predictor (odds ratio = 4.08, CI 95% = 2.56-6.48). The Norton Scale has reasonable scores for sensitivity (46.8%), specificity (61.8%) and risk prediction (OR = 2.16, CI 95% = 1.03-4.54). The Waterlow Scale offers a high sensitivity score (82.4%), but low specificity (27.4%); with a good risk prediction score (OR = 2.05, CI 95% = 1.11-3.76). Nurses' clinical judgement (only considered in three studies) gives moderate scores for sensitivity (50.6%) and specificity (60.1%), but is not a good pressure ulcer risk predictor (OR = 1.69, CI 95% = 0.76-3.75). CONCLUSION: There is no evidence that the use of risk assessment scales decreases pressure ulcer incidence. The Braden Scale offers the best balance between sensitivity and specificity and the best risk estimate. Both the Braden and Norton Scales are more accurate than nurses' clinical judgement in predicting pressure ulcer risk.     

Validity and reliability of the braden scale and the influence of other risk factors: a multi-centre prospective study

The Braden scale is one of the most intensively studied risk assessment scales used in identifying the risk of developing pressure sores. However, not all studies show that the sensitivity and specificity of this scale is sufficient. This study, therefore, investigated whether adding new risk factors can enhance the sensitivity and specificity of the Braden scale. The Braden scale was tested in a prospective multi-centre design. The nurses of 11 wards filled in the Braden scale every 5 days for each patient who was admitted without pressure sores and who had a probable stay of at least 10 days. Based on a literature study and in-depth interviews with experts, the Braden scale was extended by the risk factor blood circulation. In addition, other risk factors, which are more or less stable patient characteristics, were measured during the admission of the patient. Independent research assistants measured the presence of pressure sores twice a week. As the external criterion for the risk of developing pressure sores, the presence of pressure sores and/or the use of preventive activities was used. Results showed that the original Braden scale was a reliable instrument and that the sensitivity and specificity was sufficient. However, reformulating the factors moisture and nutrition, and adding the risk factor age could enhance the sensitivity and specificity. Furthermore, results showed that the factors sensory perception, and friction and shear were especially important risk factors for the Braden scale. In fact, using only the factors sensory perception, friction and shear, moisture (a reformulated factor) and age give the highest explained variance of the risk of developing pressure sores. The added risk factor blood circulation, did not enhance the sensitivity and specificity of the original Braden scale. Suggestions are given on how to use risk assessment scales in practice.