Sharp Catherine A, McLaws Mary-Louise
Hospital Infection Epidemiology Surveillance Unit, School of Public Health Community Medicine, The University of New South Wales, Sydney, NSW 2052, Australia.
Int Wound J. 2006 Dec;3(4):344-53. doi: 10.1111/j.1742-481X.2006.00261.x.
The aim of the current method of screening patients is to identify risk factors that are considered to cause, or contribute to, pressure ulcer (PU) development. Yet screening has not resulted in a reduction in pressure ulcer development. The literature was reviewed to identify the level of evidence for the inclusion of risk factors in six published pressure ulcer risk-screening tools. Evidence for each risk factor was ranked according to the National Health and Medical Research Council levels of evidence with a modification. Three of 19 risk factors (mobility, continence and nutrition) included in more than one screening tool have been tested for association with pressure ulcer development. While varying degrees of immobility and decreased serum albumin are reported to significantly increase the risk for PU development, the direction of the relationship, i.e. causal or resultant of PU, is not always clear. No publications reported a significant causal link between incontinence and PU development. Inclusion of risk factors for PU in screening tools must be evidence based. Until other risk factors have been tested for positive predictive value, the Ramstadius approach to screening is the only evidence-based tool.
当前患者筛查方法的目的是识别被认为会导致或促成压疮（PU）形成的风险因素。然而，筛查并未使压疮的发生率降低。对文献进行了回顾，以确定六个已发表的压疮风险筛查工具中纳入风险因素的证据水平。根据澳大利亚国家卫生与医学研究委员会的证据水平并做了修改，对每个风险因素的证据进行了排名。在不止一种筛查工具中包含的19个风险因素中，有三个（活动能力、大小便失禁和营养状况）已被测试与压疮形成的相关性。虽然据报道不同程度的活动受限和血清白蛋白降低会显著增加发生压疮的风险，但这种关系的方向，即因果关系还是压疮导致的结果，并不总是明确的。没有出版物报道大小便失禁与压疮形成之间存在显著的因果联系。在筛查工具中纳入压疮风险因素必须基于证据。在其他风险因素的阳性预测价值得到测试之前，Ramstadius筛查方法是唯一基于证据的工具。
