Construction Of ICU Pressure Ulcer Risk Assessment Scale

ObjectivesThe aim of this study was to identify the risk factors of pressure ulcer in ICU patients by Meta-analysis.Delphi method was used to establish the pressure ulcer risk assessment scale for ICU patients based on Meta-analysis,which have relatively strong predictive ability and good operational practice.The scale is to provide a scientific theoretical basis for effective pressure ulcer evaluation and prevention of pressure ulcer in clinical nursing,and achieve the purpose of reducing or avoiding pressure ulcers in ICU patients.Methods1.Literatures about related risk factors of pressure ulcer in ICU patients were searched.To extract the data required for analysis according to Meta analysis needs.The data of the included documents were exacted after the literature screening and analyzed by STATA 13.0.The heterogeneity of the literatures were tested and odds ratio(OR)and its 95% confidence interval(95% CI)were combine.Sensitivity analysis was performed by re-analyzing the data by changing the effect model.Finally,the funnel chart,Begg's test and Egger's test were used to evaluate the publication bias.2.A summary of the ICU patients with pressure ulcer risk factors entry quantification and classification to develop evaluation indicators.Delphi method was used to select and weight indicators.Final construction of ICU pressure ulcer risk assessment scale.3.Convenient sampling method was used to select the patients who were admitted to the ICU of a tertiary hospital in Guangzhou city from June 2017 to December 2017.The self-made scale was used to assess the risk of pressure ulcers,and to evaluate the reliability and validity of the scale and determine the critical value.Results1.Totally 31 literatures were recruited.According to the consistency of the risk factors,sixteen risk factors were involved,and age,male,infection,diabetes mellitus,anemia,albumin,cardiovascular disease,fecal incontinence,edema,APACHE ? score,ICU length of stay,vasoactive drugs,mechanical ventilation were identified as having cumulative effects on pressure ulcer among ICU patients.Combining OR and 95%CI values were 1.04(1.03-1.06),1.86(1.29-2.68),3.79(1.62-8.86),2.25(1.70-2.98),2.23(1.39-3.58),3.09(2.22-4.29),2.99(1.83-4.87),3.82(2.25-6.48),2.91(1.66-5.13),1.10(1.04-1.17),1.13(1.06-1.21),2.51(1.58-3.98)and1.85(1.17-2.92),respectively.2.The ICU pressure ulcer risk assessment scale constructed by two rounds of expert consultation including 10 items.The recovery rates of the two rounds of questionnaires were 95.53% and 100%,and the coefficient of authority(Cr)was 0.90,indicating that the experts are more motivated and authoritative.After two rounds of consultation,all indicators met the screening criteria.The coefficient of variation(CV)of the two rounds of experts was between 0.04 to 0.26 and 0.06 to 0.16.The coordination coefficients(Kendall's W)were 0.294 and 0.375,indicating that the experts' opinions were well coordinated.Indicator weights between 0.090 to 0.107.3.Reliability and validity test: internal consistency reliability: Cronbach's a coefficient was 0.793 and the split-half reliability coefficient was 0.824.Inter-rater consistency reliability: Intraclass correlation coefficientis(ICC)was 0.97(P<0.001),each entry ICC was 0.481-1.000.Content validity: The Item-level CVI(I-CVI)of each item was greater than 0.80,and content-validity index of the scale was 0.96.Discriminant validity: The ICU pressure ulcer risk assessment scale scores were significantly lower in pressure ulcer patients than in non-pressure ulcer patients,the difference between the two groups was statistically significant(P<0.001).Concurrent validity: The Braden scale was used as a benchmark of the ICU pressure ulcer risk assessment scale.Results showed a correlation coefficient between the two scales was r= 0.536(P<0.001).Predictive validity: The area under the ROC curve(AUC)was 0.951(P<0.001).When the predictive value was defined as 31,the predictive effectiveness is ideal,and the corresponding sensitivity(Se),specificity(Sp),positive predictive value(PPV)and negative predictive value(NPV)were 94.74%,87.64%,62.06% and 98.74%,respectively.The predictive effectiveness of the ICU pressure ulcer risk assessment scale at a cutoff of 31 points is better than the Braden scale at a cutoff of 12 points.ConclusionsThe ICU pressure ulcer risk assessment scale entries developed in this study constitute a good sensitivity and representativeness.The scale has a good reliability and validity and is suitable for the assessment of pressure ulcer risk in ICU patients.It provides a more scientific and accurate assessment tool for assessing pressure ulcer risk in ICU patients.