Translation, Revision And Application Of Intensive Care Unit-specific Pressure Injury Risk Assessment Scale

Objectives:(1)Translate the English version of the intensive care unit-specific pressure injury risk assessment scale(RAPS-ICU)into Chinese,and evaluate its reliability and validity.(2)Apply the Chinese edition of the RAPS-ICU scale to explore its clinical effects with the Braden scale and Norton scale in ICU patients,and compare the predictive power of the three.Methods:(1)The Chinese version of the scale was introduced:In this study,the RAPS-ICU scale was chineseized according to the steps of the cross-cultural adjustment guide,and finally the evaluation version of the RAPS-ICU scale was formed.(2)Reliability and validity tests: From September 2021 to December 2021,400 ICU patients admitted to a tertiary first-class hospital in Changsha,Hunan Province,were selected as research subjects.The critical ratio method and correlation coefficient method were used to analyze the items of the scale,and the internal consistency reliability,inter-evaluator reliability,structural validity,content validity,calibration validity,and prediction validity were used to test the reliability validity of the scale.(3)Scale application : 189 patients admitted to the ICU of a tertiary hospital in Hunan Province from December 2021 to January 2022 were selected for stress injury assessment,and each patient was assessed using the Chinese version of the RAPS-ICU scale,the Braden scale and the Norton scale,and compare the sensitivity,specificity,ROC curve and other indicators of the three to evaluate their predictive ability.Results:(1)The Chinese version of the scale was introduced: In the process of Chinese version and revision,the entry of "nutrition" was added to the entries of the original scale in accordance with the experts’ opinions,and the language expression was adjusted and amended for some contents that did not conform to the expression habits of the domestic language,but the rest of the scale was not changed.(2)Reliability and validity tests:(1)Item analysis: In this phase of the study,all entries of the first and last assessments had CR values greater than 3.00.The correlation coefficients were greater than 0.2,and all were statistically significant(P<0.05).(2)Occurrence of pressure injury: A total of 400 ICU patients were evaluated in this phase of the study,and 20 of them ended up with real pressure injury,and the incidence of pressure injury was 5%.Of these,18(90%)were stage 1pressure injuries and 1(5%)each were stage 2 and unstageable pressure injuries.The largest proportion of pressure injuries occurred in the sacrococcygeal region,at 50%.(3)Scale reliability: the Cronbach’s αcoefficient of the scale was 0.734,and the inter-rater reliability was 0.997.(4)Scale validity: The scale was rated by 10 experts,all of whom scored I-CVI above 0.80 and the S-CVI of the entire scale at 0.94.For the Chinese version of the RAPS-ICU scale Exploratory factor analysis was performed on the Chinese version of the RAPS-ICU scale,and a total of two common factors with eigenvalues >1 were extracted,with a cumulative variance contribution rate of 55.977%.The bivariate correlation coefficients between the Chinese RAPS-ICU scale total score and the Braden scale total score were 0.533 and 0.536 for the first and last assessments,respectively,and were statistically significant(P<0.01).(5)Comprehensive predictive power: When the diagnostic cut-offs of the first and last assessments were 19 and 23,the Yoden index was 0.568 and0.390,the sensitivity was 75.00%,70.00%,the specificity was 81.84%,68.95%,and the AUC was 0.836 and 0.728.(6)Risk level grading: total score<17,indicating that ICU patients are at high risk of PI;total score is between 17 and 18,indicating that ICU patients are at moderate risk of PI;total score≥19: indicating that ICU patients are at low risk of PI.(3)Scale application: A total of 189 ICU patients were evaluated in this phase of the study,and at the time of the initial assessment,the diagnostic cut-offs of the Chinese edition of the RAPS-ICU scale,braden scale and Norton scale were 19,14 and 12,respectively,and the AUC was 0.822,0.596 and 0.718,respectively.At the time of the last evaluation,the diagnostic cut-offs of the Chinese editions of the RAPS-ICU scale,braden scale,and Norton scale were 21,15,and 14,respectively,and the AUC was 0.740,0.715,and 0.736,respectively.Conclusion: The Chinese version of the RAPS-ICU scale introduced in Chinese chemistry has good reliability and validity,which can be used for the evaluation of stress injury in domestic ICU patients.Compared with the Braden scale and the Norton scale,the Chinese version of the RAPS-ICU scale and the Norton scale have comparable predictive power and are superior to the Braden scale.However Chinese version of the RAPS-ICU scale entries are based on risk factors specific to ICU patients and are considered easy to use by evaluators,making them more suitable for use in ICU.