Kottner Jan, Halfens Ruud, Dassen Theo
Centre for Humanities and Health Sciences, Department of Nursing Science, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
Int J Nurs Stud. 2009 Oct;46(10):1307-12. doi: 10.1016/j.ijnurstu.2009.03.014. Epub 2009 Apr 29.
Measurement error can seriously affect the validity of pressure ulcer risk assessment and of pressure ulcer classification.
Determination of interrater reliability and agreement of pressure ulcer risk and pressure ulcers using the Braden scale and the EPUAP system.
Duplicate assessments by trained nurses during two nationwide pressure ulcer prevalence surveys in the years 2007 and 2008 in The Netherlands in the home care setting.
Home care clients which participated in 2007 (n=352) and 2008 (n=339) in the pressure ulcer prevalence surveys.
The Braden scale was used to assess pressure ulcer risk. Skin examination was conducted to detect pressure related tissue damages and to classify them according to the EPUAP.
In 2007 and 2008, Intraclass Correlation Coefficients for Braden scale sum scores were 0.90 (95% CI: 0.88-0.92) and 0.88 (95% CI: 0.85-0.91) respectively, and corresponding Standard Errors of Measurement were 1.00 and 0.98. 95% limits of agreement were -2.8 to 2.8 and -2.7 to 2.7 respectively. The items "moisture", "sensory perception" and "nutrition" contained largest amounts of measurement error. Proportions of agreement for the classification of pressure ulcers were 96% and interrater reliability was 0.81 and 0.79. Most disagreements were observed for the classification of grade 1 pressure ulcers.
The standardized study procedure applied in the annual nationwide pressure ulcer prevalence surveys leads to reliable and reproducible results regarding pressure ulcer risk and pressure ulcer prevalence in the home care setting. Researchers and practitioners should be careful when drawing inferences from single pressure ulcer risk factors included in the Braden scale. Descriptions of the items "moisture", "sensory perception" and "nutrition" should be made more clearly and unambiguous.
测量误差会严重影响压疮风险评估及压疮分类的有效性。
使用Braden量表和欧洲压疮咨询小组（EPUAP）系统确定评估者间信度以及压疮风险和压疮的一致性。
在2007年和2008年荷兰全国范围内的两次家庭护理机构压疮患病率调查中，由经过培训的护士进行重复评估。
参与2007年（n = 352）和2008年（n = 339）压疮患病率调查的家庭护理客户。
使用Braden量表评估压疮风险。进行皮肤检查以检测与压力相关的组织损伤，并根据EPUAP进行分类。
2007年和2008年，Braden量表总分的组内相关系数分别为0.90（95%CI：0.88 - 0.92）和0.88（95%CI：0.85 - 0.91），相应的测量标准误分别为1.00和0.98。一致性界限的95%分别为 - 2.8至2.8和 - 2.7至2.7。“潮湿”、“感觉”和“营养”项目包含的测量误差最大。压疮分类的一致性比例分别为96%，评估者间信度分别为0.81和0.79。1期压疮分类中观察到的分歧最多。
在年度全国压疮患病率调查中应用的标准化研究程序，对于家庭护理机构中的压疮风险和压疮患病率可得出可靠且可重复的结果。研究人员和从业者在从Braden量表中单个压疮风险因素进行推断时应谨慎。应更清晰明确地描述“潮湿”、“感觉”和“营养”项目。
