| Objective:To construct a venous thromboembolism risk assessment scale for adult burn patients and perform reliability and validity testing to provide a reference tool for clinical staff to screen adult burn patients for venous thromboembolism risk.Methods:1.A project team was established to establish a framework for a risk assessment scale for venous thromboembolism in adult burn patients through extensive literature research,to identify risk factors for venous thromboembolism in adult burn patients and surgical inpatients,and to develop a pool of entries for a risk assessment scale for venous thromboembolism in adult burn patients.2.The initial scale for assessing the risk of venous thromboembolism in adult burn patients was formed by correspondence with experts in burn units and vascular surgery in12 tertiary-level general hospitals in nine provinces and cities across China through the Delphi method,and weights were calculated and assigned to each entry of the scale using the analytic hierarchy process.3.Retrospective collection of medical records of adult burn patients admitted to the burn unit of the First Affiliated Hospital of the Army Medical University from January 2015 to December 2022 for venous thromboembolism risk assessment.The initial scale entries for venous thromboembolism risk assessment in adult burn patients were screened,and the final scale was established and evaluated for reliability and validity and predictive validity.Results:1.In this study,10 domestic and international databases in English and Chinese were searched by literature system evaluation,and a total of 5448 literature related to burn venous thromboembolism were retrieved,and 11 literature were finally included in the study for Meta-analysis after stratified screening.The results showed that age,length of bed rest,ICU admission,days of ICU stay,total burn area,inhalation injury,lower extremity burns,trauma infection,number of procedures,mechanical ventilation,and D-dimer were all independent risk factors for the development of venous thromboembolism in adult burn patients.The pool of entries for the venous thromboembolism risk assessment scale for adult burn patients was constructed to include 6 level 1 entries,27 level 2 entries,and 83 level 3 entries.2.A total of 24 experts participated in the correspondence inquiries,and the experts’ working years were(22.83 ± 6.59)years.The positive coefficients for the two rounds of expert correspondence were 92.3% and 100%,the expert authority coefficients were 0.860 and 0.864,and Kendall harmony coefficients were 0.339 and 0.431,respectively.The initial scale for venous thromboembolism in adult burn patients developed included 6 primary entries,26 secondary entries,and 58 tertiary entries.The entries at each level were assigned by the analytic hierarchy process,and the consistency scale coefficients ranged from 0.000 to 0.051,all <0.1.3.The finalized risk assessment scale for venous thromboembolism in adult burn patients included 23 entries,Exploratory factor analysis extracted 5 common factors with a cumulative variance explained of 58.959%.The dimensions of the scale and the total scale of the correlation coefficients were 0.572 ～ 0.868(P < 0.01),and the inter-dimensional correlation coefficients was 0.186 ～ 0.545(P < 0.01).The content validity index of each item of the scale was 0.857 ～ 1.00,and the content validity index of the unanimous scale was 0.826,and the content validity index of the average scale was 0.980.The correlation coefficient between the scale and the Caprini Risk Assessment Model was 0.683(P <0.001).The total Cronbach’s Alpha coefficient for the scale was 0.839.The area under the ROC curve of the scale was 0.840.The optimal diagnostic threshold for the scale was 35 points,with a sensitivity of 83.87%,a specificity of 69.08%,and a Jorden index of 0.530;scores 35 ～ 36 are low risk,37 ～ 43 are intermediate risk,and ≥ 44 are high risk.Conclusion:1.The risk assessment scale for venous thromboembolism in burn patients constructed in this study has good reliability and validity and can be used as a reference tool for health care providers to screen adult burn patients for the risk of venous thromboembolism. |
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