Pressure ulcers: effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial)
Pressure ulcers: effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial)
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DOI：
10.1136/bmjqs.2010.043109
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发表时间：
2011-04-01
影响因子：
5.4
通讯作者：
McClymont, Alice
中科院分区：
文献类型：
--
作者：
Webster, Joan;Coleman, Kerrie;McClymont, Alice
目的：评估两种压疮筛查工具对临床判断在预防压疮的有效性。设计：一项单盲随机对照试验。设置：一个大都市三级医院。参与者：1231例内科或肿瘤科住院患者。排除患者，如果他们的住院时间预计为2天或less.Interventions：参与者分配到任何一个Waterlow（n=410）或Ramstadius（n=411）筛选工具组或临床判断组（n=410），没有正式的风险筛选instruments.Main结局措施：医院获得性压疮的发病率定期直接观察确定。使用任何设备的预防压疮，文件的压力计划和任何饮食或专科皮肤完整性review recorded.Results：入院时，71（5.8%）患者有一个现有的压疮。两组的医院获得性压疮发生率相似（临床判断28/410（6.8%）; Waterlow 31/411（7.5%）; Ramstadius 22/410（5.4%），p=0.44）。在回归模型中与压力损伤的显着关联包括需要饮食转诊，从一个位置以外的家庭和年龄超过65 years.Conclusion：作者发现没有证据表明，两种常见的压力溃疡风险评估工具是上级的临床判断，以防止压力损伤。与使用这些工具相关的资源可能更好地用于仔细的日常皮肤检查和改善针对特定风险的管理。
Objective: To evaluate the effectiveness of two pressure-ulcer screening tools against clinical judgement in preventing pressure ulcers.Design: A single blind randomised controlled trial.Setting: A large metropolitan tertiary hospital.Participants: 1231 patients admitted to internal medicine or oncology wards. Patients were excluded if their hospital stay was expected to be 2 days or less.Interventions: Participants allocated to either a Waterlow (n=410) or Ramstadius (n=411) screening tool group or to a clinical judgement group (n=410) where no formal risk screening instrument was used.Main outcome measure: Incidence of hospital acquired pressure ulcers ascertained by regular direct observation. Use of any devices for the prevention of pressure ulcers, documentation of a pressure plan and any dietetic or specialist skin integrity review were recorded.Results: On admission, 71 (5.8%) patients had an existing pressure ulcer. The incidence of hospital-acquired pressure ulcers was similar between groups (clinical judgement 28/410 (6.8%); Waterlow 31/411 (7.5%); Ramstadius 22/410 (5.4%), p=0.44). Significant associations with pressure injury in regression modelling included requiring a dietetic referral, being admitted from a location other than home and age over 65 years.Conclusion: The authors found no evidence to show that two common pressure-ulcer risk-assessment tools are superior to clinical judgement to prevent pressure injury. Resources associated with use of these tools might be better spent on careful daily skin inspection and improving management targetted at specific risks.