Comparison Of The Predictive Effectiveness Of Three Pressure Ulcer Risk Assessment Scales Among Emergency Patients

ObjectiveThe objectives of this study are to learn the normal situation of pressure ulcers in emergency patients,to establish the critical cutoff score of the Braden,modified Braden and Norton scales in emergency department and to compare the predictive of the three pressure ulcer risk assessment tools.MethodA descriptive study was employed in this study.The subjects were chosen from emergency department of a general hospital in Shenyang from August to November of 2008.During this period,assess and observe the subject's skin condition in a convenience sampling way.By using three pressure ulcer assessment scales(Braden, modified Braden and Norton),the subjects were assessed by ED trained nurses during 8-9 o'clock every morning under the natural light and the assessment was ensured to be completed in 24h after their admission.At the same time,the questionnaires were established to record the patient general information,preventive nursing interventions of pressure sore and the skin'sconditions.After the assessment, the researcher and the nurses monitored the skin conditions every shift until the patients were discharged to home,hospitalized,developing pressure ulcers,or death.SPSS 13.0 was used for data analysis.ResultThere were ninty-nine patients developing one-hundred-four parts of pressure ulcers(5.4%),among which,57(45.9%) at stageâ… ,66(53.2%) at stageâ…¡,and 1 (0.8%) at stageâ…¢.Most of the pressure ulcers were located at sacral area.The peak time of the occurrence of the pressure ulcer is at the 24th,48th and 72th of the stay in the Emergency Department.In emergency patients,the ideal cutoff point for Braden scale is 17,the sensitivity, specificity,positive predictive vaule,negative predictive value were:82.83%,81.74%, 20.7%,98.8%,respectively.The cutoff point for modified Braden scale is 20,and the above predictive validity were:82.83%,83.37%,22.3%,98.8%,respectively.And the cutoff point for Norton scale is 14,the predictive validity were:82.83%,78.20%, 17.9%,98.8%,respectively.ConclusionIt is recommended that it should further strengthen the Emergency Patient pressure ulcer prevention and care with the connection to first-aid and the other resuscitative care in the emergency department.The Braden scale,modified Braden scale and Norton scale can be all used to assess the risk of pressure ulcer in the emergency patients.The three scales used in this study all demonstrated a better sensitivity and specificity.The three scales had the same ability to identify positive pressure ulcer groups and negative pressure ulcer groups.On the other hand,the three scales can all overpredict pressure ulcer development that may lead to greater misuse of nursing resources.The Norton scale tends to overpredict more than the other two sacles.The specificity for the modified Braden scale is more effective than the other two scales,so it is recommended first to use modified Braden scale in Emergency Department.