Study Of The Predictive Ability Comparision Of The Three Pressure Ulcer Risk Assessment Scales For Intraoperative Acute Pressure Ulcer On Surgical Patients

Objectives:The purpose of this study was to compare and evaluate the predictive capability and determine the optimal diagnostic boundary value of three kinds of pressure ulcer risk assessment scale(Braden scale,Norton scale and Waterlow scale)on surgical patients.The aims were to predict the risk factor of pressure ulcer rapidly and effectively and provided the theoretical basis of risk prediction to select the effective pressure ulcer risk assessment scale for operation room nursing staff,develop targeted preventive measures,use limited medical resources more effectual,and reduce the incidence of intra-operative acute pressure ulcer.Besides,it provided the basis of improvement of scale which was more appropriate to be used to assess the risk factor of intraoperative acute pressure ulcer by the investigation of the occurrence and prognosis of patients with intraoperative acute pressure ulcer,analysis of intraoperative acute pressure ulcer relevant indicators and reliability and validity of three kinds of pressure ulcer risk assessment scale.Methods:Convenience sampling method was adopted,and patients who prepared for operations in a tertiary a hospital in Henan province from January 1st 2015 to June 30th 2015 were selected as the objects of this study.Set up a research group and unified training,after the pre-experimental measurement,the reliability of the research team of 5 investigators was reliable.383 objects were made risk assessment at preoperative visit time(4 pm-5 pm)one day before the operation with Braden scale,Norton scale and Waterlow scale,then established the patient general information questionnaire,recorded the patient skin condition and the score situation.On the day before the surgery,the general information of the patients and relevant index were completed,evaluated patients' pressure ulcer according to the international NPUAP/EPUAP pressure ulcer rating system recommended by National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel and completed the relevant information at the time they got to leave the operating room after surgery.Spss22.0 software was used for data entry and statistical analysis.The internal consistency reliability of the scale was evaluated by Cronbach's alpha.The structural validity of the scale was evaluated by principal component analysis and factor analysis.The optimal diagnostic value of the scale was selected according to the maximum principle of Youden index.Three kinds of scores were analysed and compared by using the Receiver Operator Characteristic Curve(ROC),sensitivity and specificity,predictive value and the area under the curve of ROC.Results:?In this research,383 surgical patients were the subjects.Among them,there were 21 cases with intraoperative acute pressure ulcers,and the incidence rate was 5.48%.Only one case was in the?stage of intraoperative acute pressure ulcers and the incidence rate was 4.8%,and the others were in the?stage,the most common site which occurred intraoperative acute pressure ulcers was sacrococcygeal,and there were 12 cases had intraoperative acute pressure ulcer in this part,the incidence rate was 57.1%.?The Cronbach's alpha of the internal consistency reliability of the three scales was more than 0.7.The Cronbach's alpha of Braden scale after removing the "nutrition" item was the highest(0.875),Norton scale after removing "physical condition" item was the highest(0.733),and other scales were obviously low(the Cronbach's alpha were less than 0.7).?After rotation transformation of the three kinds of scales,the number of items which characteristic value was more than 1,was 4 of Braden scale 6 items,was 4 of Norton scale 5 items,and was 5 of Waterlow scale 7 items.The Norton scale had fewer entries that were deviated from the original set of entries.The results of the factor matrix showed that all the entries of the three scales could be well expressed.?The optimal diagnosis cutoff points of Braden,Norton and Waterlow scales were 16,18 and 14,respectively;the corresponding area under the ROC curve were 0.635,0.717 and 0.624;Among the three scales,the Norton scale of AUC was the largest,and the predictive ability was the best,and the corresponding sensitivity and specificity which were the most balanced were 76.19%,57.46%.Conclusions:?The Braden scale,Norton scale and Waterlow scale had a practical value in the assessment of the risk of intraoperative acute pressure ulcer on surgical patients.?Norton scale diagnostic value was medium level.The sensitivity and specificity of the optimal diagnostic boundary value were balanced,and the corresponding detection ability,the ability to identify and the diagnostic value were better than Braden scale and Waterlow scale.For the prediction of intraoperative acute pressure ulcer in the operation,Norton scale was priority selection by nurse.At this very moment,The optimal diagnosis cutoff points of Norton was 18.?There was revised space in three kinds of scales.The items of"nutrition" in Braden scale should be put in the first consideration in improving the reliability of the scale.?It need to be further improved to obtain the Pressure Ulcer Risk Assessment Scales for surgical patients with intraoperative acute pressure ulcers.