Munro与Braden压疮评估表用于手术患者压疮评估预测效度比较

目的比较Munro与Braden评估表预测手术患者压疮的效果。方法 2名护士分别应用2种评估表,同时、独立、连续地于术前、手术结束、术后返回病房2h内对111例外科手术患者进行压疮风险评估,另1名护士在手术结束、返回病房交接、术后24h、48h、72h评估压疮发生情况并记录,计算ROC曲线下面积、灵敏度和特异度。结果手术结束11例发生压疮(9.9%),术后24h内共有4例压疮患者,其中2例新发(1.8%);Munro评估表术前、中、后的ROC曲线下面积分别为0.850、0.889、0.864,高于Braden评估表(0.727、0.724、0.600);术前、中、后Braden评估表最佳临界值分别为19分、13分、14分,灵敏度分别为0.545、0.909、0.250,特异度0.700、0.350、0.916;术前、中、后Munro评估表最佳临界值为9分、22分、29分,灵敏度分别为0.818、0.909、0.750,特异度为0.610、0.730、0.822。结论 Munro评估表评估压疮更具有针对性,对手术压疮诊断价值高于Braden评估表,但在使用过程中需要与其他医务人员配合,且个别评估指标不是常规监测项目,增加了护理工作量,需进一步研究和加以完善。     

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.     

Reliability and validity of the Braden Scale for predicting pressure ulcer risk.

Multiple tools have been developed to assist nurses and other care providers to identify and quantify pressure ulcer risk. One of the most widely used tools is the Braden Scale for Predicting Pressure Ulcer Risk. It has been in use for 2 decades and multiple studies have individually reported on its reliability and validity. This article summarizes the reliability and validity of the instrument, and discusses implications for its use in clinical and research settings. The Braden Scale for Predicting Pressure Ulcer Risk has generally performed well in the clinical setting. It has demonstrated reliability and validity in multiple clinical settings, and its parsimonious format enhances incorporation into routine clinical practice. Expanding the instrument may further increase its reliability and validity in the research setting.     

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。     

手术室压疮风险评估表在术中压疮高危患者中的应用

目的探讨手术室压疮风险评估表在术中压疮高危患者中的效果。方法选择2014年1～3月我科手术患者116例,随机分为两组,每组58例,对照组给予常规压疮预防护理,观察组在对照组基础上采用自制手术室压疮风险评估表进行评估,并对中重度危险的患者给予针对性预防措施。比较两组患者压疮发生情况。结果 2014年1～3月我科采用自制手术室压疮风险评估表评估高危患者58例,所有压疮风险评估正确,护理干预措施落实到位,观察组压疮发生1例,发生率为1.7%。对照组压疮发生6例,发生率为10.3%,两组患者压疮发生率比较差异有统计学意义（χ^2=4.435,P〈0.05）。结论应用自制手术室压疮风险评估表,使手术室护士能正确、客观评价患者各方面情况,正确的评估压疮高危患者,提高手术压疮风险的预见性,及时采取有效的护理干预措施,减少了术中压疮的发生。     

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。     

Concordance of Shape Risk Scale,a new pressure ulcer risk tool,with Braden Scale

The occurrence of pressure ulcers was examined in a cross‐sectional study in 23 health care facilities and in home care involving 548 patients. The screening of pressure ulcer risk was assessed simultaneously using the Braden Scale and the new Shape Risk Scale (SRS), and the results were compared. The overall prevalence of pressure ulcers in the study population was 15·5% (85/548). The Braden Scale was performed as described in the literature. The direct concordance of the Braden and SRS scales was 46%. In more than 90% of cases, the SRS classified patients as well as or better than the Braden Scale. The SRS allocates patients significantly different from the Braden Scale into the risk categories, especially the difference is significant between the low and medium‐risk categories. The greatest advantage of SRS to Braden Scale is that it correctly identifies patients with low risk of pressure ulcers. It is interesting that the two risk scores, taking into consideration the basically different pathophysiological factors, can still give rather similar results. The users considered that both scales are easy to use.     

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.     

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.     

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.     

Waterlow量表用于结核病患者压疮评估准确性分析

目的 了解Waterlow量表用于住院结核病患者压疮评估符合率,分析不符合的原因,为针对性改进提供参考.方法 对Waterlow量表评分≥10分的209例住院结核病患者,统计其连续2次(共418例次)评分符合率.结果 209例中58例评分完全符合,符合率27.75％;各条目评分符合率由低至高依次为体形、皮肤类型、组织营养不良、运动能力、控便能力、药物治疗、大手术/创伤、神经系统缺陷,符合率55.98％～83.33％.结论 护士应用Waterlow量表评估结核病患者压疮危险因素的符合率较低,不准确的原因有量表解读缺如、护士知识欠缺及质量控制不力等,针对性改进可望提高住院结核病患者压疮评估符合率.     

Effects of a hydroxyethylstarch solution on plasma colloid osmotic pressure in acutely ill patients

Hydroxyethyl starch (HES) solutions can represent an alternative to human albumin solutions in intensive care unit (ICU) patients, but their effects on the plasma colloid osmotic pressure (COP) have not been well defined. We studied the changes in COP in 61 critically ill patients; 39 patients received 500 ml HES 6% (Elo-Haes Fresenius solution) and 22 received 400 ml of a human albumin solution (4% albumin Belgian Red Cross) over 60 to 90 min. COP was determined with an oncometer, using a semi-permeable membrane at 30 Kd, before the infusion, at the end of the infusion, and one hour and four hours after the end of the infusion. COP increased in the HES group from 20.7 +/- 3.1 to 22.5 +/- 3.1 mmHg (p < 0.05), and this increase in COP was sustained throughout the 4 hours of the study. COP did not increase in the human albumin group (from 19.5 +/- 2.4 to 19.9 +/- 2.0 mmHg, NS). Hence, this standard HES solution has greater effects on COP than natural colloids. In view of their lower costs, HES solutions can represent a valuable alternative to human albumin. However, it is necessary to consider the secondary effects of HES and the physiologic functions of albumin.     

Development and validation of a pressure ulcer risk assessment tool for acute hospital patients

The purpose of this study was to develop and validate a pressure ulcer risk assessment for acute hospitals. This tool was developed in a cohort of 342 patients with a mean age 63 years (SD 19.82) and validated in a second cohort of 165 patients with a mean age 68 years (SD 18.40). Risk factors for inclusion on The Northern Hospital Pressure Ulcer Prevention Plan (TNH‐PUPP) were identified from the literature then examined and weighted using logistic regression. Risk factors included on the TNH‐PUPP were requires assistance to move in bed (odds ratio [OR] 5.15; 95% confidence interval [CI]: 2.49–10.65), admission to intensive care during current admission (OR 2.98; 95% CI: 1.33–6.67), aged ≥65 years (OR 2.81; 95% CI: 1.24–6.36), reduced sensation (OR 2.29; 95% CI: 1.19–4.42), and cognitive impairment (OR 2.26; 95% CI: 1.09–4.67). The TNH‐PUPP was validated in a prospective sample. The new tool had high diagnostic validity (area under the receiver operating curve=0.86), consistent in the validation sample (area under the receiver operating curve=0.90). The TNH‐PUPP has a moderate positive predictive value (development=0.50; validation=0.13), and a high negative predictive value (development=0.94; validation=0.99) enabling low‐risk patients to be screened out, as noncandidates for pressure ulcer prevention interventions. An accurate pressure ulcer risk assessment has been developed and validated, which identifies a high‐risk group to whom limited pressure ulcer prevention resources should be directed. The TNH‐PUPP facilitates effective resource allocation and is likely to reduce unnecessary patient harm and costs from pressure ulcers in acute hospitals.     

COMHON量表和Braden量表在ICU纵隔术后患者压力性损伤风险评估中的比较

目的比较COMHON量表和Braden量表在ICU纵隔手术后患者压力性损伤风险评估中的预测效能。方法便利选取胸腔外科行纵隔手术治疗后入住ICU的232例患者为研究对象,采用COMHON量表和Braden量表对其进行压力性损伤风险评估。结果在72 h观察期内共29例(12.5%)患者发生压力性损伤,分期均为1期。使用两种量表评估时,压力性损伤组与非压力性损伤组量表总评分差异有统计学意义(均P0.01)。Braden量表ROC曲线下面积为0.747,当总分为13.5分时,约登指数为0.522,预测价值最大;COMHON量表ROC曲线下面积为0.976,当总分为9.5分时,约登指数为0.828,预测价值最大。结论 Braden量表和COMHON量表均可有效评估ICU纵隔手术后患者压力性损伤发生风险,而COMHON量表的预测效能高于Braden量表。     

Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: a prospective cohort study

The purpose of this study was to identify pressure ulcer (PU) incidence and risk factors that are associated with PU development in patients in two adult intensive care units (ICU) in Saudi Arabia. A prospective cohort study design was used. A total of 84 participants were screened second daily basis until discharge or death, over a consecutive 30‐day period, out of which 33 participants with new PUs were identified giving a cumulative hospital‐acquired PU incidence of 39·3% (33/84 participants). The incidence of medical devices‐related PUs was 8·3% (7/84). Age, length of stay in the ICU, history of cardiovascular disease and kidney disease, infrequent repositioning, time of operation, emergency admission, mechanical ventilation and lower Braden Scale scores independently predicted the development of a PU. According to binary logistic regression analyses, age, longer stay in ICU and infrequent repositioning were significant predictors of all stages of PUs, while the length of stay in the ICU and infrequent repositioning were associated with the development of stages II–IV PUs. In conclusion, PU incidence rate was higher than that reported in other international studies. This indicates that urgent attention is required for PU prevention strategies in this setting.     

Hemodynamic assessment of poor risk and critically ill patients

An approach to the early detection and guided correction of early decompensation of the stressed cardiovascular system in the elderly surgical patient or any critically iii patient is described. The ease, safety, and relatively low cost of this method make it applicable to the community hospital and allow the rapid and repeated reassessment of seriously ill patients with little discomfort or risk to the patient.     

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.