Haalboom J R, den Boer J, Buskens E
Department of Internal Medicine, Utrecht University Hospital, The Netherlands.
Ostomy Wound Manage. 1999 Feb;45(2):20-6, 28, 30-4.
Some screening tools exist for assessing increased risk of the development of pressure ulcers, but none of these tools has undergone actual testing for validity and predictive value. This is important in clinical practice because the combination of high sensitivity and rather low specificity implies that the number of patients at increased risk is overestimated and thus overtreated (i.e., unnecessary preventive measures are taken). Risk scores are usually composed of items considered to influence the development of pressure ulcers. Although for some scoring systems attempts have been made to enhance specificity by changing the cutoff points or the relative value of individual items, good results have not been achieved. The influence that individual items have on the development of pressure ulcers and the impact of this influence on score outcomes has not yet been established. In this study, 65 patients with and 58 patients without pressure ulcers were compared using all of the known risk factors analyzed by multivariate logistic regression. We found that only the Norton, Douglas, and Dutch Consensus Meeting scoring systems appeared to predict the development of pressure ulcers. Also, it appeared that incontinence for urine and the presence of both neurologic disorders and friction forces to the skin effectively predict the development of pressure ulcers. Considering the important implications of this study, a larger study--consisting of several thousand patients--should be performed to assess in more detail the variables currently perceived as risk factors and construct and evaluate a scoring system based on these results.
存在一些用于评估发生压疮风险增加的筛查工具，但这些工具均未经过有效性和预测价值的实际测试。这在临床实践中很重要，因为高敏感性和相当低的特异性相结合意味着发生风险增加的患者数量被高估，从而接受了过度治疗（即采取了不必要的预防措施）。风险评分通常由被认为会影响压疮发生的项目组成。尽管对于一些评分系统已尝试通过改变临界点或单个项目的相对值来提高特异性，但尚未取得良好效果。单个项目对压疮发生的影响以及这种影响对评分结果的作用尚未确定。在本研究中，使用多变量逻辑回归分析的所有已知风险因素对65例有压疮的患者和58例无压疮的患者进行了比较。我们发现只有诺顿、道格拉斯和荷兰共识会议评分系统似乎能预测压疮的发生。此外，尿失禁以及神经疾病和皮肤摩擦力的同时存在似乎能有效预测压疮的发生。考虑到本研究的重要意义，应该进行一项由数千名患者组成的更大规模的研究，以更详细地评估目前被视为风险因素的变量，并基于这些结果构建和评估一个评分系统。
