Application Study Of The Chinese Version Of COMHON Pressure Injury Risk Assessment Scale In ICU Patients

Objectives To introduce and translate foreign COMHON pressure injury riskassessment scale,and compare and evaluate the reliability,validity and predictive ability of COMHON-C pressure injury risk assessment scale and Braden pressure injury risk assessment scale,select the appropriate pressure injury risk assessment scale for ICU patients,reduce the incidence of pressure injury in ICU patients,optimize medical resources,and provide a theoretical basis for the development of ICU patient pressure injury prevention guide.Methods According to the Internationally recognized Brislin's translation principles,we translated and translated back the scale and made cultural adaptation after getting in touch with Professor Cobs Vegas and getting his authorization,and then we got the initial Chinese version of COMHON scale.Six experts in related fields were selected to test the content validity of the scale,three nurses were selected to access twenty-one patients by using the initial scale and we got the inter-rater reliability.At last,we got the Chinese version of COMHON scale COMHON-C by organizing and revising the above tests and feedback results.A total of 416 patients as the subjects were evaluated for skin pressure injury risk by COMHON-C scale and Braden scale respectively,All the subjects were treated in the intensive care units of a third grade and class-A hospitals in Hefei,Anhui province from September 2016 to October 2017 and selected by convenience sampling method.At the same time,the patients' general information table was set up to fill in the situation of the skin condition and the score.Validity of two kinds of scales were compared by using content validity,Exploratory Factor Analysis and Confirmatory Factor Analysis.Reliability of two kinds of scales were compared by using inter-rater reliability,Cronbach's alpha and sensitivity analysis.The predictive ability of two scales were compared by using Sensitivity,Specificity,Positive predictive value,negative predictive value,the Receiver Operator Characteristic Curve's(ROC)and the area under the curve of ROC(AUC).Epi Data3.1 software was used for data entry,SPSS25.0,Med Calc17.6 and AMOS21.0 software were used for statistical analysis.Results(1)416 patients were involved in this research and 63 cases of pressure injury occurred in the hospital,the incidence rate was 15.1%.Among them,53(84.1%)at stage?,10(15.9%)at stage?,no other stages of pressure injury.The most prone site was sacrococcygeal,there were 46 cases,the incidence rate was 73%,followed by the site of the heel with a total of 9 cases(14.3%).(2)Validity of the scales:Expert content validity evaluation result showed that,the average content validity(S-CVI)of COMHON-C scale and Braden scale respectively 0.966 and 0.972.The each item content validity(I-CVI)were 0.83~1.00.Exploratory factor analysis results showed that,COMHON-C scale and Braden scale were both extracted two factors with characteristic value more than one,accounted for 72.601% and 60.817% respectively of the total variance,the factor loads corresponding to each item were respectively 0.576~0.939 and 0.512 ~ 0.873;Confirmatory factor analysis results showed that,the CMIN/DF of COMHON-C scale and Braden scale were respectively 1.691 and 1.527,the GFI were 0.997 and 0.994,the AGFI were 0.976 and 0.974,the NFI were 0.995 and 0.987,the RMSEA were 0.041 and 0.036,and the RMR were 0.005 and 0.008.(3)Reliability of the scales:Inter-rater reliability results showed that,the kandall coefficient of concordace of COMHON-C scale and Braden scale were respectively 0.314 and 0.269(P<0.05),the intraclass correlation coefficient(ICC)were 0.864 and 0.900.The Cronbach's alpha coefficient results show that,the first and last of COMHON-C scale and Braden scale were respectively 0.802~0.818 and 0.639~0.650;Item sensitivity analysis results showed that,the Cronbach's alpha of COMHON-C scale has not been improved after deleting any item than before,The Cronbach's alpha of Braden scale improved significantly after deleting the "activity" and "friction&shear" items.(4)Comprehensive predictive ability:the first and last optimal diagnosis cut off points of COMHON-C scale were 12 and 11,Braden scale were 11 and 12,the corresponding sensitivity and specificity which were the most balanced,the area under the ROC curve(AUC)were 0.722~0.820 and 0.675~0.683(P<0.05),the difference was statistically significant.Conclusions ICU patients were still high risk groups of hospital-acquired pressure injury,medical workers must pay high attention to it,choose appropriate pressure injury risk assessment tool,and take preventive measures to reduce its occurrence.The COMHON-C scale was better than Braden scale in terms of reliability and comprehensive predictive ability,At the same time,it has contribute to clinical nurses quickly and accurately identify pressure injury risk patients by its objective and brief items,so it can be preferred application.