Curley Martha A Q, Razmus Ivy S, Roberts Kathryn E, Wypij David
Critical Care and Cardiovascular Nursing Research, Children's Hospital, Boston, Massachusetts 02115, USA.
Nurs Res. 2003 Jan-Feb;52(1):22-33. doi: 10.1097/00006199-200301000-00004.
While there are valid and reliable pressure ulcer risk assessment tools available for adult patients, none exist for infants and children. To remedy this, the Braden Scale was adapted for use in pediatrics, calling it the Braden Q Scale.
The purpose of this study was to: (a) establish the predictive validity of the Braden Q Scale in an acutely ill pediatric population; (b) determine the critical cutoff point for classifying patient risk; and (c) determine the best time to assess patient risk.
A multisite prospective cohort descriptive study with a convenience sample of 322 patients on bedrest for at least 24 hours without pre-existing pressure ulcers or congenital heart disease were enrolled from three pediatric intensive care units (PICU). The Braden Q score and skin assessment were independently rated and data collectors were blind to the other measures. Patients were observed up to 3 times per week for 2 weeks and then once a week until PICU discharge for a median of 2 observations reflecting 887 skin assessments.
Eighty-six patients (27%) developed 199 pressure ulcers; 139 (70%) were Stage I pressure ulcers, 54 (27%) were Stage II pressure ulcers, and 6 (3%) were Stage III pressure ulcers. Most pressure ulcers (57%) were present at the first observation. Using Stage II+ pressure ulcer data obtained during the first observation, a Receiver Operator Characteristic (ROC) curve for each possible score of the Braden Q Scale was constructed. The area under the curve (AUC) was 0.83. At a cutoff score of 16, the sensitivity was 0.88 and the specificity was 0.58. The Braden Q Scale was then modified to eliminate 4 subscales with an AUC <0.7. With 3 subscales (mobility, sensory perception, tissue perfusion/oxygenation) the AUC of this Modified Braden Q Scale was maintained at 0.84. At a cutoff score of 7, the sensitivity was 0.92 and the specificity was 0.59.
The performance of the Braden Q Scale in a pediatric population is similar to that consistently reported for the Braden Scale in adult patients. The Modified Braden Q Scale, with 3 subscales, provides a shorter yet comparable tool.
虽然有适用于成年患者的有效且可靠的压疮风险评估工具，但尚无适用于婴儿和儿童的此类工具。为弥补这一不足，布拉登量表被改编用于儿科，称为布拉登Q量表。
本研究的目的是：（a）确定布拉登Q量表在急性病儿科人群中的预测效度；（b）确定分类患者风险的临界分界点；（c）确定评估患者风险的最佳时间。
一项多中心前瞻性队列描述性研究，从三个儿科重症监护病房（PICU）纳入了322例卧床休息至少24小时、无既往压疮或先天性心脏病的患者作为便利样本。布拉登Q评分和皮肤评估由不同人员独立评定，数据收集者对其他测量结果不知情。患者每周观察多达3次，共观察2周，然后每周观察1次，直至从PICU出院，中位数为2次观察，共进行了887次皮肤评估。
86例患者（27%）发生了199处压疮；139处（70%）为I期压疮，54处（27%）为II期压疮，6处（3%）为III期压疮。大多数压疮（57%）在首次观察时就已存在。利用首次观察期间获得的II期及以上压疮数据，为布拉登Q量表的每个可能得分构建了受试者工作特征（ROC）曲线。曲线下面积（AUC）为0.83。分界分为16分时，敏感性为0.88，特异性为0.58。然后对布拉登Q量表进行修改，去除了4个AUC<0.7的子量表。保留3个子量表（活动能力、感觉知觉、组织灌注/氧合）后，改良布拉登Q量表的AUC维持在0.84。分界分为7分时，敏感性为0.92，特异性为0.59。
布拉登Q量表在儿科人群中的表现与一直报道的布拉登量表在成年患者中的表现相似。改良布拉登Q量表保留3个子量表，提供了一个更简短但相当的工具。
