Construction And Application Of Risk Assessment Scale For Infant Diaper Dermatitis

ObjectiveThe "infant diaper dermatitis Risk Assessment Table" was studied and constructed,and its reliability and validity were evaluated,so as to clarify the diagnostic threshold and clinical application effect of the scale,so that clinical medical staff could screen infants at high risk of infant diaper dermatitis in time,and intervene early to reduce the incidence of infant diaper dermatitis in hospitalized infants.MethodsThe first stage: The risk factors of infant diaper dermatitis were screened by literature review and focus group interview,and the entry pool of infant diaper dermatitis risk assessment scale was initially developed.The Delphi method was used for expert consultation,and the scale items were screened and optimized according to the expert opinions and discussion of the research group,and the test version of infant diaper dermatitis risk assessment scale was formed.The second stage: A total of 210 cases of infants and toddlers in a grade-A children’s hospital in Anhui province were selected by cross-sectional survey and convenient sampling method.The risk assessment form version was used to investigate the infants and toddlers with diaper dermatitis.Univariate and multivariate Logistic regression were used to analyze the risk factors of infant diaper dermatitis and further screen and optimize the scale items.The optimal critical value of infant diaper dermatitis risk assessment scale was obtained by drawing ROC curve,and risk stratification was carried out by using percentile method to form the official version of infant diaper dermatitis risk assessment scale.The scale validity was evaluated by content validity,prediction validity and structure validity.Inter-rater reliability,internal consistency reliability evaluation scale reliability;After the scale was applied,qualitative interview method was used to further optimize the scale through the feedback of clinical nurses.Results1 Formation of initial entry pool of infant diaper dermatitis risk assessment scaleAccording to the literature review results,a total of 23 target literatures were screened out.Through literature analysis,qualitative interview,group discussion,and based on clinical practice,22 related factor item pools were preliminarily determined.The contents included 3 first-level indicators(basic state,perineal environment,related treatment and nursing)and 22 second-level indicators.After grading each item,a grading system of 1-4 was adopted to assign values.2 Screening of scale items2.1 Items of Delphi Expert Letter Inquiry Screening ScaleExpert opinions were basically unified after the two rounds of consultation,and the next round of consultation was not continued.The positive coefficient of Delphi experts in the two rounds was 95% and 100%,the expert authority coefficient was 0.92 and0.93,and the expert coordination coefficient was 0.376 and 0.407(P <0.001).According to the experts’ opinions and the discussion of the research group,the infant diaper dermatitis risk assessment scale was preliminarily formed.Among them,there are three primary indicators,including basal state,related treatment and care,and perineal environment.Secondary indicators 13.2.2 Regression analysis of scale itemsLogistic regression analysis was performed on the evaluation results of 210 children,and each item of the scale was incorporated into the univariate Logisitic regression model.Among the 13 items included,other indicators were associated with the occurrence of diaper dermatitis except for the items "past diaper dermatitis" and "body temperature".There was statistical difference(P<0.05).Therefore,the entries "previous diaper dermatitis" and "body temperature" were deleted to further simplify the scale.Finally,11 secondary indexes are included in the scale.3 Confirmation of scale diagnostic threshold and risk levelThe area under ROC curve of the total score of infant diaper dermatitis risk assessment scale was 0.833.When the diagnostic threshold was > 24,the maximum Youden index was =0.534.At this time,the sensitivity,specificity,PPV and NPV of the infant diaper dermatitis risk assessment scale in the diagnosis of infant diaper dermatitis were 78.95%,74.42%,40.5 and 94.1,respectively.At this time,the predictive validity of the scale was the best,and the diagnostic critical value of ROC curve was determined as 24 points.The risk degree of infant diaper dermatitis was graded according to the percentile method,with low risk of 11～20 points,moderate risk of 21～26 points and high risk of ≧27 points.4 Reliability and validity evaluation of scaleThe content validity of the scale is guaranteed based on Delphi method.KMO test showed that KMO=0.78 > 0.5 and Barlett sphericity test < 0.001,indicating that the scale had good structural validity.The area under ROC curve of the scale was 0.833,indicating that the scale had good predictive validity.The reliability coefficient among evaluators was 0.927 and Cronbach’s α coefficient was 0.701,indicating high consistency and stability of the scale.5 Feedback results of infant diaper dermatitis risk assessment Scale Pediatric clinical nurses’ feedback on the use of infant diaper dermatitis risk assessment scale constructed by this institute mainly includes three aspects:(1)Clear and detailed setting of scale items,accurate scoring and simple use;(2)It is suggested to adjust the "stool type" entry to "stool characteristics",more accurate,fit clinical.(3)All the nurses who were interviewed expressed their willingness to continue using this scale and looked forward to further modification and improvement.ConclusionThe infant diaper dermatitis risk assessment scale constructed in this paper contains 11 items,with a diagnostic threshold of 24 points.The scale has a good ability to predict infant diaper dermatitis.Clinical medical staff can quickly identify children at high risk of diaper dermatitis by using this scale.This scale can be used as a preliminary screening tool for clinical assessment of the risk of infant diaper dermatitis.