Application Of The Scott Triggers In The Risk Assessment Of Intraoperative Acquired Pressure Injury

Pressure injuries,as an important indicator of the quality of care,have been widely concerned in health care institutions or settings.Patients who undergo surgery are considered to be at higher risk of pressure injuries due to immobility,sensory impairment,and blood perfusion fluctuation during the operation,all of which may increase the risk of pressure injury.Therefore,the management of intraoperative acquired pressure injury has become the focus point and difficult problem in clinical practice.Accurate assessment and early interventions are very important measures to prevent pressure injuries.However,many nurses lack of insufficient understanding and judgement of high-risk factors about surgical-related pressure injuries,and there is no effective assessment tool used in clinical practice.Foreign researcher Scott has launched an assessment tool for pressure injuries in surgical patients,that is,the Scott Triggers.This tool currently lacks effective verification in surgical patients in China.This study introduced the Scott Triggers tool and test the effectiveness and feasibility of the Scott Triggers tool applied to domestic surgical patients,which provides an important reference value for the clinical evaluation and prevention of surgical injury among surgical patients.Objectives:To introduce the English version of the Scott Triggers tool,translate it into the Chinese version,and carry out the reliability and validity tests;To apply the Scott Triggers tool initially to assess the risk of intraoperative acquired pressure injury in domestic surgical patients,comparing prediction validity and clinical feasibility of the Scott Triggers tool and the Munro scale in order to provide reference for the selection of appropriate assessment tools for Chinese surgical patients;To Initially apply the Scott Trigger tool to assess the risk of pressure injury among surgical patients,and describe the results of pressure injury risk assessment for surgical patients with different characteristics.Methods:(1)The Brislin double translation-back translation mode and the expert group meeting were adopted to translate and revise the English version of the ST score,and to verify the reliability and validity.(2)The Chinese version of the Scott Triggers tool was applied in assessing the risk of intraoperative acquired pressure injury among surgical patients.A convenience sample of 413 patients from a tertiary hospital in Shanghai were included.The risk of pressure injuries were assessed,using both the Scott Triggers Tool and the Munro Scale.Indicators like the sensitivity,specificity,and the area under the ROC curve of the two assessment tools were calculated.Bayes discriminant analysis was also used to analyze the evaluation accuracy of the two assessment tools.A total of 20 nurses were selected using a convenient sampling method.10 nurses were selected to assess 10 surgical patients using the Scott Triggers tool,and another 10 nurses assessed 10 surgical patients using the Munro scale,respectively.And recording the time they used for the assessment.The risk of acquired intraoperative pressure injury during operation at different operating time and age was compared assessed by the Scott Triggers Tool.Results:(1)Introduction and revision of the Scott Triggers tool: The intraclass correlation coefficient ICC is 0.917,and the ICC value is greater than 0.75,indicating that the Scott Triggers tool is reproducible;the Spearman correlation coefficient of the ST score and the Munro scale rs = 0.654,P <0.001,indicating that there is a positive correlation between the Scott Triggers tool and the Munro;The area under the ROC curve(AUC)is 0.670(P <0.05,95%: 0.598-0.737),and the Scott Triggers tool is statistically significant in the risk assessment of pressure injury in surgical patients.(2)Application of the Scott Triggers tool in surgical patients:(1)Comparison of the evaluation results between the Scott Triggers tool and the Munro scale: The total score of the Scott Triggers tool and the Munro scale in PI group was higher than that without PI,and there were also significant differences in these two assessment scales(all P<0.05).The area under the curve of the Scott Triggers Tool and the Munro scale was 0.626(95%CI: 0.578-0.673)and 0.670(95%CI:0.622-0.715).There was no statistically significant difference in the area under ROC between them(Z=1.011,P=0.312).The cross-validation method of Bayes discriminant analysis suggested that the accuracy of the Scott Triggers Tool and the Munro scale were 89.80% and 89.60%respectively.(2)Comparison of time required for the assessment by the Scott Triggers tool and the Munro scale:The average time required for the assessment using the Scott Triggers and the Munro scale is 1.55±0.86 minutes and 5.05±1.93 minutes,respectively.The time required for the Scott Triggers is far less than the Munro scale.(3)Risk assessment of the Scott Triggers in surgical patients with different characteristics:With the operation time and age increase,the proportion of high-risk patients with acquired pressure injury increases during the operation.The changing trend of the average operation time and age among patients with pressure injury correspondss to the rate of high-risk pressure injury patients assessed by the Scott Triggers.Conclusions:(1)The Chinese version of the Scott Triggers tool has good reliability and validity and can be used to screen high-risk patients of acquired pressure injury during surgery,which can provide a reference for the subsequent application of the Scott Triggers tool among surgical patients.(2)The Scott Triggers tool can be used to evaluate the risk of pressure injury in surgical patients,but with a modest prediction effect.Compared with the Munro scale,the assessment items of the Scott Triggers tool are all objective questions and convenient to use.Both of the predictive ability is similar.However,the sample size of the research needs to be further expanded in the future.Based on the characteristics of Chinese surgical patients,the scale items of the Scott Triggers tool should be revised to improve the accuracy of the assessment.