The Development And Application Of The Acquired Pressure Injury Assessment Scale In Neurosurgery Patients

Objective: The aim of this study was to construct a intraoperative acquired pressure injury assessment scale in neurosurgery patients,evaluate the reliability and validity of the scale,certain the best diagnostic value of the scale,and apply it to neurosurgery patients to provide a basis for the prevention of acquired pressure injury in neurosurgery.Methods: This study consisted of three stages,The first stage,through literature researching,clinical medical records reviewing,referring to the existent pressure injury assessment scales and relying on the 2019 guidelines for the prevention of pressure injuries,the item pool of intraoperative neurosurgery acquired pressure injury assessment scale was established.Two rounds of Delphi expert consultation was used to form the initial assessment scale.In the second stage,convenience sampling method was used to select patients who underwent neurosurgery in a Class III Grade A hospital in Shenyang from March to September 2022 for evaluation.Critical ratio method,correlation coefficient method and Cronbach’s α coefficient method with deletion of an item were used for project analysis;Cronbach’s α coefficient and the split half reliability were used for reliability evaluation;Content validity index of scale level and item level was adopted for scale content validity;Prediction validity was used to determine the optimal diagnostic threshold,ROC curve area,sensitivity and specificity of the scale.In the third stage,the reliability and validity tested scale was used to assess the risk of 158 patients undergoing neurosurgery in a Grade A hospital in Shenyang,and the predictive ability of the scale was evaluated by sensitivity and specificity.Results: 1.Delphi expert consultation results: A total of 17 experts participated in the consultation.The questionnaire recovery rate of the two rounds of consultation were100%.In the first round of consultation,the expert opinion proposal rate was 59%,the expert opinion authority degree was 0.91.In the second round of consultation,the expert opinion proposal rate was 18%,the expert opinion authority degree was 0.92.The item importance score of the first round of expert consultation ranged from(3.76±1.39)to(4.88±0.33),and the item coefficient of variation ranged from 0.07 to 0.37.The item importance score of the second round of expert consultation ranged from(3.82±1.29)to(4.94 ± 0.24),and the item coefficient of variation ranged from 0.05 to 0.34.The coordination coefficients of the two rounds of expert consultation were 0.188 and 0.242,respectively.Finally,the assessment scale including 17 items was formed by two rounds of expert consultation.2.Reliability and validity test: The final assessment scale for intraoperative acquired pressure injury in neurosurgery included 16 items.The Cronbach’s α coefficient of the scale was 0.632,the split-half reliability was 0.642,the content validity index was 0.888,and the item level content validity index of the scale was 0.800-1.000.3.Scale diagnostic threshold: The area under the ROC curve was 0.880,and the best diagnostic cutoff value was 31.The corresponding sensitivity and specificity were 80.0% and 84.9%,respectively.4.Application effect evaluation: Among 158 patients,the incidence of blanchable erythema was 13.92%,and the incidence of intraoperative pressure injury was 5.06%.The sensitivity and specificity of the scale were 62.50% and 84.00% respectively.Conclusion: The evaluation scale of intraoperative acquired pressure injury for neurosurgery patients constructed in this study has good reliability and validity,with a risk assessment threshold of 31 points.The scale has good predictive ability and can be used as a risk assessment tool for intraoperative acquired pressure injury for neurosurgery patients.