Risk-assessment tools in the prevention of pressure ulcers.
Risk-assessment tools in the prevention of pressure ulcers.
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预防压疮的风险评估工具。
DOI：
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发表时间：
1999
期刊：
影响因子：
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通讯作者：
E. Buskens
中科院分区：
文献类型：
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作者：
J. Haalboom;J. D. den Boer;E. Buskens
存在一些筛选工具来评估压疮发展的风险增加，但这些工具都没有经过实际的有效性和预测价值的测试。这在临床实践中很重要，因为高敏感性和低特异性的结合意味着风险增加的患者数量被高估，从而被过度治疗（即采取不必要的预防措施）。风险评分通常由被认为影响压疮发展的项目组成。虽然有些评分系统试图通过改变分界点或单项的相对价值来增强特异性，但效果并不好。个别项目对压疮发展的影响以及这种影响对评分结果的影响尚未确定。在这项研究中，65例有压疮的患者和58例无压疮的患者进行比较，使用多变量logistic回归分析所有已知的危险因素。我们发现只有Norton， Douglas和Dutch Consensus Meeting评分系统可以预测压疮的发展。此外，尿失禁、神经系统疾病和皮肤摩擦力的存在似乎可以有效地预测压疮的发展。考虑到这项研究的重要意义，应该进行一项更大的研究——由几千名患者组成——以更详细地评估目前被认为是风险因素的变量，并根据这些结果构建和评估评分系统。
Some screening tools exist for assessing increased risk of the development of pressure ulcers, but none of these tools has undergone actual testing for validity and predictive value. This is important in clinical practice because the combination of high sensitivity and rather low specificity implies that the number of patients at increased risk is overestimated and thus overtreated (i.e., unnecessary preventive measures are taken). Risk scores are usually composed of items considered to influence the development of pressure ulcers. Although for some scoring systems attempts have been made to enhance specificity by changing the cutoff points or the relative value of individual items, good results have not been achieved. The influence that individual items have on the development of pressure ulcers and the impact of this influence on score outcomes has not yet been established. In this study, 65 patients with and 58 patients without pressure ulcers were compared using all of the known risk factors analyzed by multivariate logistic regression. We found that only the Norton, Douglas, and Dutch Consensus Meeting scoring systems appeared to predict the development of pressure ulcers. Also, it appeared that incontinence for urine and the presence of both neurologic disorders and friction forces to the skin effectively predict the development of pressure ulcers. Considering the important implications of this study, a larger study--consisting of several thousand patients--should be performed to assess in more detail the variables currently perceived as risk factors and construct and evaluate a scoring system based on these results.