Development of the DESIGN-R with an observational study: An absolute evaluation tool for monitoring pressure ulcer wound healing
Development of the DESIGN-R with an observational study: An absolute evaluation tool for monitoring pressure ulcer wound healing
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DOI：
10.1111/j.1524-475x.2011.00674.x
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发表时间：
2011-05-01
影响因子：
2.9
通讯作者：
Miyachi, Yoshiki
中科院分区：
文献类型：
--
作者：
Matsui, Yuko;Furue, Masutaka;Miyachi, Yoshiki
DESIGN是日本压疮学会科学教育委员会于2002年开发的压疮7项（深度、渗出物、大小、炎症/感染、肉芽、坏死和囊袋）监测量表。设计是一个非常有用的工具，按时间顺序监测每一个压疮，但该工具的一个关键限制是它无法比较伤口愈合过程中不同的压疮在不同的患者，由于缺乏统计项目的权重。我们的目标是通过统计分析来衡量设计项目，并开发一种新的有效工具来克服这一限制。受试者包括3，601例压疮患者。在研究期间，每周对患者进行随访。为了确定每个项目和等级的权重，我们使用多变量考克斯回归分析估计了12个月随访时伤口愈合的概率。按最高等级排序的每个项目的权重（-β值）为：囊袋，2.289;大小，1.573;炎症/感染，0.778;肉芽组织，0.682;渗出物，0.543;和坏死组织，0.529。基于这些研究结果，开发了一种新的、经过验证的用于监测压疮愈合进展的"ORGN评级工具"，这意味着开发了一种绝对的评估工具和临床指标来评估医疗护理质量。
DESIGN is a seven-item (depth, exudates, size, inflammation/infection, granulation, necrosis, and pocket) monitoring scale for pressure ulcers developed in 2002 by the scientific education committee of the Japanese Society of Pressure Ulcers. DESIGN is a very useful tool for chronological monitoring of each pressure ulcer, but a key limitation of this tool is its inability to compare the wound-healing process among different pressure ulcers in different patients due to a lack of statistical item weighting. Our aim was to weight DESIGN items by statistical analysis and develop a new validated tool to overcome this limitation. Subjects comprised 3,601 patients with pressure ulcers. Patients were followed every week during the study period. To establish the weighting of each item and grade, we estimated the probabilities of wound healing at 12-month follow-up using multivariable Cox's regression analysis. Weighting (-beta value) for each item in order of the highest rank was: pocket, 2.289; size, 1.573; inflammation/infection, 0.778; granulation tissue, 0.682; exudate, 0.543; and necrotic tissue, 0.529. Based on these findings, a new, validated "DESIGN-Rating tool" for monitoring the progression of pressure ulcer healing was developed, implying the development of an absolute evaluation tool and clinical indicator to assess the quality of medical care.