Construction Of Assessment Tool For Radiation-induced Skin Ulcer And Its Guidence For Treatment And Relationship With Prognosis

Objective To initiate an assessment tool for radiation-induced skin ulcer and reach a standardized assessment for clinical use,so as to contribute to the determination of optimal therapy depending on the assessment,and initially verify the relevance of the assessment tool to treatment plan as well as prognosis.Methods A questionnaire was designed by reviewing the literatures and referring the logic of assessment tools of wound diseases including diabetic foot ulcer,pressure injury,lower extremity vascular ulcer and discussing within the research group.16 experts in wound healing were engaged in the consultation within two rounds of Delphi method.The experts’concordance coefficient were analyzed by Chi-suqare test,the experts’positive coefficient as well as experts’authority coefficient were analyzed by checking the feedback.Using analytic hierarchy process to compare the mean score of every two indicators,which show their relative importance.According to Saaty’scale to establish pair-wise comparison matrices,calculating weigh of indicators by square root method,and measuring the consistency in pair-wise comparison by calculating the CR(consistency ratio),then use the final weigh of indicators to confirm the score of each indicator and accomplish the assessment tool.A prospective observational study was conducted that included Patients with radiation-induced skin ulcers who met the inclusion and exclusion criteria attending our Wound Healing and Repair Clinic from December 1,2018 to January 1,2020.Evaluating the wounds of included patients by the assessment tool established before,meanwhile collecting the basic information of these patients,then followed up until the end points,which was wound healing or death or for at least 3 months.ROC(Receiver Operating Characteristic curve)was used to analyze the predictive ability of the assessment tool for treatment methods and prognosis,and the best predictive value and Area Under Curve(AUC)were obtained.Results The established assessment tool for radiation-induced skin ulcer contains 2 first-level indicators,10 second-level indicators and 35third-level indicators.Within the two rounds of consultation,the positive coefficient were 87.50%and 100%respectively.The expert authority coefficient(Cr)was 0.936.The Kendall’s coefficient of concordance W for two rounds consultation were 0.231 and 0.147 respectively,and the?~2were 131.977 and 87.849 by Chi-square test with the P value of being less than 0.05.The difference presented statistically.After determining the weight of each indicator of the assessment tool by the analytic hierarchy process,the consistency ratio CR of all levels of indicators is less than 0.1.ROC curve analysis shows that the assessment tool has the largest Yoden index of 0.641 and the AUC is 0.8269 for predicting the treatment method when the score of the assessment tool is 27.5,P value is0.0138,the difference is statistically significant.The ROC curve analysis for the prognosis of the assessment tool showed that the area under the curve was 0.6445 and the P value was 0.1632.The difference was not statistically significant.Conclusion 1.Experts show high enthusiasm toward this research,and have reliable authority.The expert evaluation opinions were well coordinated,thus the results were credible.The established assessment tool for radiation-induced skin ulcer was verified scientific and reliable.The tool also seems easy to be used in clinic.By use of this assessment tool,the therapeutic plan of radiation-induced skin ulcer could be made in a more standardized way.2.The weights of all levels of indicators calculated by the analytic hierarchy process are satisfactory,and the consistency test results are satisfactory,indicating that the indicator of the radiation skin ulcer assessment tool is scientific,reliable and reasonable.3.The radiation-induced skin ulcer assessment tool can better judge the treatment method,but it is not recommended for prognosis judgment.When using the radiation-induced skin ulcer assessment tool to select a patient’s treatment plan,it is recommended to use 27.5 points as the cutoff.When the patient’s wound score exceeds 27.5 points,surgical treatment is considered first,otherwise conservative treatment is considered first.