3种评估表对消化科老年患者压疮预测效果的比较

目的比较Braden、Norton、Waterlow3种压疮评估表对消化科老年患者压疮的预测效果。方法运用Braden、Norton、Wa-terlow3种评估表对于消化科住院的204例患者(年龄≥60岁)进行压疮评估和皮肤完整性检查,计算各评估表首次、末次评估灵敏性、特异性、阳性预测值、阴性预测值和ROC曲线下面积。用Pearson相关系数、Kappa值评价量表间一致性。结果 204例中,压疮发生率为8.82%;Braden、Norton、Waterlow3种评估表评估表最佳临界值首次评估分别为14、14和17分,末次评估分别为Waterlow与Braden12、12和19分;ROC曲线下面积首次评估分别0.85、0.85和0.90,末次评估分别0.93、0.94和0.95。首次及末次评分的总体一致性差异有统计学意义(均P0.05)。Kappa值显示Waterlow末次评分与实际观测结果内部一致性最好(0.609)。结论 Waterlow评估表对消化科老年患者压疮的预测效果较好。     

汉化版Cubbin & Jackson量表与Braden量表在ICU压疮风险评估中的应用比较

目的测定Braden量表、汉化版CubbinJackson量表在ICU患者中使用的临床效度。方法由2名调查员应用Braden量表、汉化的CubbinJackson量表同时对169例入住ICU患者进行压疮风险评估,计算各评估工具的灵敏度、特异度、阳性预测值、阴性预测值。结果169例中发生压疮25例,Braden量表及汉化的CubbinJackson量表的预测临界值分别在13分和24分时灵敏度、特异度、阳性预测值、阴性预测值最佳;Braden量表的灵敏度、特异度、阳性预测值、阴性预测值分别为32.00%、90.97%、38.09%、88.51%,汉化版CubbinJackson量表分别为56.00%、95.14%、66.67%、92.57%;两者的ROC曲线下面积分别是0.63和0.88。结论汉化版CubbinJackson量表较Braden量表更适合于ICU患者的压疮风险评估。     

基于决策树的肿瘤患者难免性压疮风险预测模型研究

目的评价决策树预测肿瘤患者难免性压疮风险的准确性与合理性,为压疮预防提供依据。方法收集Braden评分高风险肿瘤患者611例的临床病例资料,采用CHAID算法构建肿瘤患者难免性压疮风险预测的决策树模型,并通过ROC曲线下面积、灵敏度和特异度指标比较其与Braden评分的预测效果。结果 46例发生难免性压疮,发生率为7.53%。决策树模型包含3层共11个节点,提取6条分类规则,筛选出4类高危人群,即Braden评分≤11分,翻身计划无法落实;Braden评分11分,皮肤有现存或潜在损伤;Braden评分≤11分,翻身计划可以落实,但存在增加压疮发生风险的特殊情况;Braden评分11分,皮肤没有现存或潜在损伤,但翻身计划无法落实。决策树模型ROC曲线下面积为0.840;决策树模型的灵敏度为0.848、特异度为0.774。结论决策树模型ROC曲线下面积、灵敏度及特异度均较好,可以用于肿瘤患者难免性压疮高危人群的筛选和管理。     

成人心血管手术压疮高危预测模型的建立与验证

目的建立成人心血管手术患者压疮高危预测模型,并验证模型的应用效果,为减少手术压疮提供参考。方法回顾性调查成人心血管手术患者1 163例,通过Logistic回归分析确定手术压疮高危因素并建立预测模型,通过ROC曲线确定临界值;在443例成人心血管手术患者中验证模型的预测效果。结果成人心血管手术压疮风险预测模型包括术前血红蛋白、前白蛋白、血钠、血钾,术中平均体温、最低平均动脉压,以及患者吸烟频率、高血压史、年龄≥70周岁;绘制ROC曲线后得出Logit P的临界值为-1.259(曲线下面积AUC=0.751)。模型的灵敏度为0.657、特异度为0.793、误诊率和漏诊率分别为0.207和0.343。结论该模型可较好地预测成人心血管手术患者的手术压疮风险。     

Braden-Q量表评估我国儿童压疮危险因素适用性研究

目的 探讨Braden-Q儿童压疮危险评估量表(下称Braden-Q量表)对国内ICU患儿压疮评估的预测效力.方法 采用儿童日常活动能力分类量表(POPC)、Braden-Q量表对133例ICU患儿进行评估.结果 POPC评分1～5(1.12±0.63)分;Braden-Q量表7个条目评分为2.10±0.89～3.84±0.43,压疮发生率为5.26%;Braden-Q量表临界值为13～16分时,灵敏度为0.15～0.23,特异度为0.96～0.98,阳性预测值为0.07～0.53,阴性预测值为0.86～0.99.结论 ICU患儿病情危重度不高,BrademQ量表临界值取15分时其灵敏度和特异度较好,Braden-Q量表对国内患儿压疮的预测效果不佳,其适用性尚需进一步扩大样本深入研究.     

压疮预防评估表的设计与应用

通过分析压疮危险因素、临床护士操作可行性及临床效果评价,设计了压疮预防评估表,应用此表对2384例神经内科住院患者进行压疮危险因素预测,根据预测结果实施针对性预防护理。结果仅1例因家属拒绝翻身致Ⅱ度压疮发生。提示压疮预防评估表预测阳性率符合临床护理工作实际,具有良好的实用价值。     

压疮预防评估表的设计与应用

通过分析压疮危险因素、临床护士操作可行性及临床效果评价,设计了压疮预防评估表,应用此表对2 384例神经内科住院患者进行压疮危险因素预测,根据预测结果实施针对性预防护理.结果仅1例因家属拒绝翻身致Ⅱ度压疮发生.提示压疮预防评估表预测阳性率符合临床护理工作实际,具有良好的实用价值.     

Braden量表对住院患者压疮危险预测效度的Meta分析

目的对前瞻性诊断研究进行Meta分析,以评价Braden量表对住院患者压疮危险预测的有效性。方法计算机检索Cochrane图书馆、PubMed、Springlink、EBSCO、中国知网、维普数据库和万方数据库和其他方式收集关于压疮危险评估量表预测压疮的前瞻性试验研究。利用诊断性研究质量评价工具(QUADAS-2)对纳入的文献进行质量评价,并采用Meta-Disc1.4软件进行数据分析。结果最终纳入20篇文献,共5 896例患者。显示合并灵敏度为0.71(95%CI0.67~0.74),合并特异度为0.69(95%CI0.68~0.70),SROC曲线下面积为0.78。结论 Braden量表作为单独指标对压疮的预测有效性为中等水平。关于Braden量表对住院患者压疮预测的有效性仍需更多研究证实。     

压疮危险因素评估表的设计及其信效度检测

目的 设计国内患者适用的压疮危险因素评估表(下称评估表),并检验其信效度.方法 分析国外压疮评估表的弊端,结合国内研究和临床实践,设计出包括神志、意识状况,营养状况,活动情况,体位变换能力,排泄控制,皮肤感觉,皮肤状况7个方面的评估表,选取5名专家,15例及7 329例住院患者分别进行内容效度(CVI)、信度(Cronbach's α系数)及临床效度(灵敏度,特异度)检验.结果 评估表CVI=0.686,Cronbach's α=0.891,灵敏度=0.843,特异度=0.729.结论 本评估表具有较稳定的信度和较好的效度,可作为医院压疮危险因素的评估工具使用.     

3种压疮评估工具的临床效度测定

目的 测定Braden、Norton、Waterlow 3种压疮评估工具在新疆患者中使用的临床效度.方法 运用3种评估工具对随机抽取的500例住院患者进行压疮评估和皮肤完整性检查.计算各评估工具的灵敏度(Se)、特异度(Sp).结果 压疮发生率为2.8%;对于全部人群,Braden量表的临床效度较好(Se=0.8571,Sp=0.7160);对于汉族患者.Braden量表的临床效度较高(Se=0.8750,Sp=0.7438);对于少数民族患者,Waterlow量表具有较高的临床效度(Se=0.8333,Sp=0.7366).结论 临床初步评估压疮时,建议首选Braden量表,对于少数民族患者,辅以Waterlow量表.     

Risk Assessment Tool for Pressure Ulcer Development in Indian Surgical Wards

The aims of this paper were to compare the predictive validity of three pressure ulcer (PU) risk scales—the Norton scale, the Braden scale, and the Waterlow scale—and to choose the most appropriate calculator for predicting PU risk in surgical wards of India. This is an observational prospective cohort study in a tertiary educational hospital in New Delhi among 100 surgical ward patients from April to July 2011. The main outcomes measured included sensitivity, specificity, positive predictive value (PVP) and negative predictive value (PVN), and the area under the curve of the receiver operating characteristic (ROC) curve of the three PU risk assessment scales. Based on the cutoff points found most appropriate in this study, the sensitivity, specificity, PVP, and PVN were as follows: the Norton scale (cutoff, 16) had the values of 95.6, 93.5, 44.8, and 98.6, respectively; the Braden scale (cutoff, 17) had values of 100, 89.6, 42.5, and 100, respectively; and the Waterlow scale (cutoff, 11) had 91.3, 84.4, 38.8, and 97, respectively. According to the ROC curve, the Norton scale is the most appropriate tool. Factors such as physical condition, activity, mobility, body mass index (BMI), nutrition, friction, and shear are extremely significant in determining risk of PU development (p < 0.0001). The Norton scale is most effective in predicting PU risk in Indian surgical wards. BMI, mobility, activity, nutrition, friction, and shear are the most significant factors in Indian surgical ward settings with necessity for future comparison with established scales.     

Relationship between Braden scale score and pressure ulcer development in patients admitted in trauma intensive care unit

The purpose of this study was to determine the relationship between the scores of Braden scale and pressure ulcer development among critically ill patients. All patients who admitted to intensive care unit (ICU) in 3 months (during July-October 2010) were surveyed with Braden scale. Patients who gained higher score of Braden scale were at lower risk for pressure ulcer development compared with the other patients. Braden scale is a useful tool for predicting pressure ulcer development in trauma ICU patients. Also, factors such as age and level of consciousness may influence pressure ulcer development.     

The Norton, Waterlow, Braden, and Care Dependency Scales: comparing their validity when identifying patients' pressure sore risk.

OBJECTIVES: We compared the sensitivity and specificity of the Norton, Waterlow, and Braden Scales in identifying patients at pressure sore risk. An additional goal was to determine whether or not the Care Dependency Scale (CDS) is able to detect patients at risk for pressure sore development. METHODS: The investigation was part of a prevalence study involving 754 patients in 3 Berlin hospitals. A questionnaire was used containing the subscales of the 3 risk calculators (Norton, Waterlow, and Braden), and the CDS. On the specified day nurses filled in the questionnaire using data obtained from the patients' charts and direct visualization of the patients' skin. RESULTS: Thirty-four out of 754 patients had at least 1 pressure ulcer. Comparing the 3 risk assessment tools, the Waterlow scale demonstrated the highest sensitivity (0.86) and the Norton scale demonstrated the highest specificity (0.75). Individuals with pressure sores were more likely to be care dependent (t-test: P< .01); 27 of them had a CDS score lower than 55. Using the score of 55 as the cut-off point, the CDS demonstrated a sensitivity of 0.74 and a specificity of 0.83. SUMMARY: This study demonstrated remarkable differences among the 3 commonly used risk assessment tools, in regards to sensitivity and specificity. Moreover, the CDS seems to have a diagnostic value similar to the 3 commonly used risk assessment calculators.     

The effect of Web-based Braden Scale training on the reliability and precision of Braden Scale pressure ulcer risk assessments.

OBJECTIVE: To evaluate the effect of Web-based Braden Scale training on the reliability and precision of pressure ulcer risk assessments made by registered nurses (RN) working in acute care settings. DESIGN: Pretest-posttest, 2-group, quasi-experimental design. SETTING AND SUBJECTS: Five hundred Braden Scale risk assessments were made on 102 acute care patients deemed to be at various levels of risk for pressure ulceration. Assessments were made by RNs working in acute care hospitals at 3 different medical centers where the Braden Scale was in regular daily use (2 medical centers) or new to the setting (1 medical center). INSTRUMENT: The Braden Scale for Predicting Pressure Sore Risk was used to guide pressure ulcer risk assessments. A Web-based version of the Detroit Medical Center Braden Scale Computerized Training Module was used to teach nurses correct use of the Braden Scale and selection of risk-based pressure ulcer prevention interventions. RESULTS: In the aggregate, RN generated reliable Braden Scale pressure ulcer risk assessments 65% of the time after training. The effect of Web-based Braden Scale training on reliability and precision of assessments varied according to familiarity with the scale. With training, new users of the scale made reliable assessments 84% of the time and significantly improved precision of their assessments. The reliability and precision of Braden Scale risk assessments made by its regular users was unaffected by training. CONCLUSION: Technology-assisted Braden Scale training improved both reliability and precision of risk assessments made by new users of the scale, but had virtually no effect on the reliability or precision of risk assessments made by regular users of the instrument. Further research is needed to determine best approaches for improving reliability and precision of Braden Scale assessments made by its regular users.     

Using the Braden subscales to assess risk of pressure injuries in adult patients: A retrospective case‐control study

The aim of this study was to compare the pressure injury risk predictability between the individual Braden subscales and the total Braden scale in adult inpatients in Singapore. A retrospective 1:1 case‐control design was used from a sample of 199 patient medical records. Clinical data were collected from a local university hospital's medical records database. The results showed that, among the six subscales, the activity subscale was the most sensitive and specific in predicting pressure injury (PI). However, the overall results showed that the Braden scale remained the most predictive of PI development in comparison with the individual subscales. The study also found that, among the Singaporean patients, the Braden cut‐off score for PI risk was 17 compared with the current cut‐off score of 18. Therefore, it may be relevant for local tertiary hospitals to review their respective Braden cut‐off scores as the study results indicate an over‐prediction of PI risk, which leads to unnecessary utilisation of resources. The hospital may also consider developing a PI prevention bundle comprising commonly used preventive interventions when at least one Braden subscale reflects a suboptimal score.     

Enhancing Braden pressure ulcer risk assessment in acutely ill adult veterans

This study sought to determine if a parsimonious pressure ulcer (PU) predictive model could be identified specific to acute care to enhance the current PU risk assessment tool (Braden Scale) utilized within veteran facilities. Factors investigated include: diagnosis of gangrene, anemia, diabetes, malnutrition, osteomyelitis, pneumonia/pneumonitis, septicemia, candidiasis, bacterial skin infection, device/implant/graft complications, urinary tract infection, paralysis, senility, respiratory failure, acute renal failure, cerebrovascular accident, or congestive heart failure during hospitalization; patient's age, race, smoking status, history of previous PU, surgery, hours in surgery; length of hospitalization, and intensive care unit days. Retrospective chart review and logistic regression analyses were used to examine Braden scores and other risk factors in 213 acutely ill veterans in North Florida with (n = 100) and without (n = 113) incident PU from January–July 2008. Findings indicate four medical factors (malnutrition, pneumonia/pneumonitis, candidiasis, and surgery) have stronger predictive value (sensitivity 83%, specificity 72%, area under receiver operating characteristic [ROC] curve 0.82) for predicting PUs in acutely ill veterans than Braden Scale total scores alone (sensitivity 65%, specificity 70%, area under ROC curve 0.70). In addition, accounting for four medical factors plus two Braden subscores (activity and friction) demonstrates better overall model performance (sensitivity 80%, specificity 76%, area under ROC curve 0.88).     

Subscales, subscores, or summative score: evaluating the contribution of Braden Scale items for predicting pressure ulcer risk in older adults receiving home health care.

PURPOSE: The purpose of this study was to determine whether certain Braden subscales or subscores were more important than others or the summative score in predicting stage I to IV pressure ulcers among older adults receiving home health care. DESIGN: A retrospective cohort study (secondary analysis) was used. SETTING AND SUBJECTS: The cohort sample included 1684 nonhospice patients who were not receiving intravenous therapy and who were admitted to the Intermittent Skilled Nursing Division of a large midwestern home health care agency between January 1995 and March 1996. The patients were > or =60 years and free of pressure ulcers. METHODS: Demographic data and data on the Braden Scale were extracted from admission information. Patient records were followed forward chronologically to 1 of 2 outcomes: development or absence of pressure ulcers (ie, free of pressure ulcers upon discharge, institutionalization, death, or the end of the study period). RESULTS: Following admission, a stage I to IV pressure ulcer developed in 107 subjects (incidence = 6.3%). Cox regression analysis revealed that activity and moisture subscale scores predicted pressure ulcer development. Regression modeling of individual Braden Scale subscores (response categories) revealed that problems with friction/shear, being very limited in mobility, and being constantly moist, very moist, or occasionally moist predicted pressure ulcer development. When the overall level of risk was added to each of these models, the Braden Scale summative score was most strongly related to pressure ulcer development. No simplified scale improved risk prediction. CONCLUSIONS: When the Braden Scale was used, the summative score rather than any subscale or subscore best predicted pressure ulcer risk among the older adults receiving home health care.