Construction Of A Risk Assessment Scale For Patients With Puncture Site Bleeding After Transradial Artery Route PCI

Objective:A scientific and feasible risk assessment scale for patients with puncture site bleeding after transradial artery route PCI was constructed,and its reliability and validity were analyzed and the boundary value was determined,so as to provide an assessment tool for clinical medical staff to accurately identify and judge the risk of patients with puncture site bleeding after transradial artery route PCI.Method:1.Preliminary construction of the scale item pool and expert letter consultation:Through literature review and analysis,retrospective analysis of clinical data and group discussion,the item pool of the scale for risk factors of bleeding at puncture site after transradial artery route PCI was constructed.Using the objective sampling method,17 experts in clinical medicine,clinical nursing and nursing management in the field of cardiovascular internal medicine were selected for two rounds of expert letter consultation,and the items of the scale were added,deleted and modified to form a risk assessment scale for patients with puncture site bleeding after transradial artery route PCI.2.Reliability and validity test of scale:Application initial shape of the radial artery path PCI postoperative patients with puncture bleeding risk assessment scale for a level of first-class hospital in nanchang,discharge standard in 304 through radial artery coronary interention patients investigation,further screening scale items,determine the scale for each item weight and diagnostic threshold,the dangerous degree classification,determine the scale and the scale test,reliability and validity of Finally,a risk assessment scale for bleeding at the puncture site for patients undergoing transradial PCI was formed.Results:1.Preliminary construction of the scale item pool and results of expert letter consultation:(1)Preliminary construction results of the scale item pool:Through literature review,risk factors were identified,including age,systolic blood pressure,compliance,hand pressure for hemostasis,gender,elective PCI,application of low molecular weight heparin within 12 h preoperatively,large amount of intraoperative heparin,intraoperative and postoperative tirofiban,abnormal prothrombin function,history of diabetes,history of hypertension.Retrospective analysis of clinical data showed that operative time,prothrombin time,platelet count,high density lipoprotein,systolic blood pressure,educational level,BMI,initial pressure and other factors were related to puncture site hemorrhage.After the topic group discussion,a scale item pool composed of 18 items from 2 dimensions was initially formed.(2)Results of expert letter consultation: in the two rounds of expert letter consultation,the enthusiasm of experts was 100%,and the proportion of experts putting forward suggestions for revision was 58.82% and 23.53% respectively;The authority coefficients of the expert consultation by letter are 0.8735 and 0.8995 respectively.The coordination coefficient(Kendall’s W)was 0.368-0.523,and the difference was statistically significant by 2test(P < 0.05).Five items(" compliance ","history of anemia","education level")were deleted in the two rounds of expert letter consultation,one item(" family care ")was added,and four items(" age "≥60 years old" and "≥75 years old" could be merged into "≥75 years old")were retained after modification."Initial pressure ≤10N" was adjusted to "Initial pressure ≤ 5N",and systolic blood pressure classification "< 139 mm Hg,140-159 mm Hg,≥ 160 mm Hg" was adjusted to "<159mm Hg,≥ 160 mm Hg",and "Operation duration < 60min" and "Operation duration 60-120min" were combined into "Operation duration < 120 min "),the preliminary assessment scale of puncture site bleeding risk for patients undergoing transradial artery route PCI had 2 dimensions and 16 items.2.Reliability and validity test results of the scale: The scale for risk assessment of bleeding at puncture site after transradial artery route PCI included 2 dimensions and 14 items.The Kronbach α coefficient of internal consistency was 0.712,the inter-evaluator reliability coefficient was 0.921,the area under ROC curve of the scale was0.714(0.602 ～ 0.823),the diagnostic threshold was 25 points,and the corresponding sensitivity and specificity were 81.5% and 56.0%,respectively.Conclusion:The risk assessment scale for patients with puncture site bleeding after transradial artery route PCI constructed in this study was divided into two dimensions of patient factors and treatment factors,with a total of 14 items and a diagnostic threshold of 25 points.The scale had good reliability,validity and predictive ability.