| Objective:To develop a scoring tool suitable for the assessment of the change of the condition and the prediction of the prognosis of patients with severe multiple trauma in ICU,test its reliability and validity,and apply the tool to the clinical work to analyze its evaluation value.Methods:Part I:after literature review and semi-structured interview,the article pool was drawn up,and 15 experts from Guizhou,Guangzhou,Chongqing and Hubei provinces or cities were consulted by letter in two rounds by Delphi method,and the item weight was determined by analytic hierarchy process to verify the reliability of the expert consultation results.The recovery rate,expert authority coefficient(Cr),coefficient of variation(CV)and Kendall's W coefficient of harmony were used to indicate the positive degree,authority degree and coordination degree of experts.Part?:160 patients with multiple injuries admitted to the comprehensive and emergency ICU of the affiliated hospital of Guizhou medical university from February to December 2018 were retrospectively collected for assessment,to verify the reliability and validity of the assessment scale.Cronbach's?coefficient and grader's correlation coefficient were used to evaluate the reliability of the scale.The validity of the scale was evaluated by content validity,structure validity,intrinsic correlation test and predictive validity.The scale's score degree was divided by median and quartile spacing.Part?:200 patients with multiple trauma admitted to the emergency ICU of affiliated hospital of Guizhou medical university from January 2019 to January 2020 were selected as the research objects by convenience sampling.With patients transferred out of ICU as the end point of observation,the changes of the illness of patients admitted to ICU were evaluated,and the significance of the assessment scale in patients'prognosis outcome,injury sites and different degrees of illness was analyzed.On prognosis of patients discharged from hospital status to the end.Draw in working curve of characteristics of the patients with multiple trauma ICU nursing monitoring and evaluation scale,with ISS scale,APACHE?scale as reference,analysis and assessment scale of prognostic value.SPSS23.0 statistical software was used for independent sample T test and repeated measurement analysis of variance.Check level=0.05.Results:Part I:the positive coefficients of the 15 experts in the 2 rounds of consultation were 93.75%and 100%.The authority coefficients were 0.835 and0.872.The degree of consensus was 0.217(?~2=118.645,P<0.01)and 0.314(?~2=155.670,P<0.01).The mean value of item importance and coefficient of variation were4.478,0.102 and 4.859,0.017.Finally,29 items in 5 dimensions including injury assessment(weight 0.199),relevant physiological score(weight 0.207),age(weight0.198),treatment measures(weight 0.197)and previous chronic diseases(weight0.199)were formed.Part?:the total Cronbach's?coefficient of ICU nursing monitoring and evaluation scale for patients with multiple trauma was 0.889,and the correlation coefficient of raters was 0.942.The content validity index of each item in the scale ranged from 0.867 to 1.000,and the total content validity index was0.948.Five common factors were extracted by exploratory factor analysis,and the contribution rate of cumulative variance was 65.878%.The area under the characteristic working curve of the patient was 0.894,the cut-off point was 21.5,the sensitivity and the specificity was 0.855and 0.745.Part?:the average score of ICU nursing monitoring and evaluation of 200 patients with multiple trauma was18.60±4.68,and the score of the death group was higher than the survival group,showing a statistical difference(t=5.311,P<0.05).There were statistically significant differences in the scores of the first and continuous assessment between different major injury sites.The scores of the head and neck injury group were higher than those of the chest injury group,the abdominal injury group and the limb injury group.The scores of the first assessment and the continuous assessment were statistically different between the groups with different degrees of illness.The scores of the very high risk group were higher than those of the low risk group,the medium risk group and the high risk group.The area under curve of ROC analysis,multiple trauma patients with ICU monitoring assessment scale(0.839)and APACHE?score(0.863)the predictive value of close are higher than the ISS score(0.701).Conclusion:The ICU nursing monitoring and evaluation scale developed in this study is scientific,reliable and has good reliability and validity.When initially applied to ICU patients with multiple injuries,,the patient's condition can be accurately evaluated,the patient's condition can be effectively recognized,and the patient's prognosis has a good predictive value,which is worthy of being recommended for clinical use. |
PDF Full Text Request