Xakellis G C, Frantz R A, Arteaga M, Nguyen M, Lewis A
Department of Family Practice, College of Medicine, University of Iowa, Iowa City.
J Am Geriatr Soc. 1992 Dec;40(12):1250-4. doi: 10.1111/j.1532-5415.1992.tb03651.x.
(1) Determine if the Braden scale or Norton scale predicted the same patients to be at risk for pressure ulcer development as were receiving preventive nursing interventions. (2) Identify the items on the Braden and Norton risk assessment scales that the nurses used intuitively to determine a patient's need for a preventive intervention.
Cross-sectional study.
Six hundred-bed, state-supported, long-term care facility.
War veterans who were 82% male and 97% caucasian, mean age 73.
(1) Patients were categorized as at-risk or not-at-risk by the Norton and Braden scales. (2) The presence of a preventive nursing intervention was noted. Agreement in assignment of at-risk status among the two assessments and presence of a preventive intervention was analyzed using Cohen's Kappa. (3) The staff nurses' use of preventive interventions was modeled using stepwise logistic regression. The items from the Braden and Norton risk assessment scales were used as independent variables with staff nurse implementation of a preventive intervention as the dependent variable.
Nurse preventive interventions were found on 45% of patients. The Norton scale identified 38% and the Braden scale identified 27% of patients as at-risk. Agreement among the three methods was 0.53. Agreement between the Braden and Norton scales was 0.73. Agreement between use of a preventive intervention and a classification as at-risk by the Braden or Norton scale was 0.41 and 0.43, respectively. Stepwise logistic regression revealed that low Braden mobility scores (Odds Ratio: 2.74) and low Braden friction/shear scores (Odds Ratio: 3.29) were associated with an increased likelihood of a patient receiving a preventive nursing intervention.
The overall level of agreement among the two scales predicting risk and the presence of a preventive intervention was not high. Agreement, however, between the two risk assessment scales was close. The staff nurses apparently relied on a patients' mobility, their exposure to friction/shear, and additional unidentified factors to guide implementation of a preventive intervention. Further study is needed to define the cost, efficacy, and related cost effectiveness of routine pressure ulcer risk assessment.
（1）确定布拉德恩量表或诺顿量表所预测的发生压疮风险的患者，是否与接受预防性护理干预的患者相同。（2）识别护士直观用于确定患者是否需要预防性干预的布拉德恩和诺顿风险评估量表中的项目。
横断面研究。
拥有600张床位的州立长期护理机构。
退伍军人，男性占82%，白种人占97%，平均年龄73岁。
（1）根据诺顿量表和布拉德恩量表将患者分为有风险或无风险。（2）记录预防性护理干预的存在情况。使用科恩kappa系数分析两种评估在风险状态分配上的一致性以及预防性干预的存在情况。（3）采用逐步逻辑回归对护士使用预防性干预的情况进行建模。将布拉德恩和诺顿风险评估量表中的项目用作自变量，将护士实施预防性干预作为因变量。
45%的患者接受了护士预防性干预。诺顿量表将38%的患者识别为有风险，布拉德恩量表将27%的患者识别为有风险。三种方法之间的一致性为0.53。布拉德恩量表和诺顿量表之间的一致性为0.73。使用预防性干预与布拉德恩量表或诺顿量表将其分类为有风险之间的一致性分别为0.41和0.43。逐步逻辑回归显示，布拉德恩量表中较低的活动能力得分（优势比：2.74）和较低的摩擦力/剪切力得分（优势比：3.29）与患者接受预防性护理干预的可能性增加相关。
预测风险的两种量表与预防性干预存在情况之间的总体一致性水平不高。然而，两种风险评估量表之间的一致性较为接近。护士显然依靠患者的活动能力、他们所受的摩擦力/剪切力以及其他未明确的因素来指导预防性干预的实施。需要进一步研究来确定常规压疮风险评估的成本、疗效及相关成本效益。
