Centre for Humanities and Health Sciences, Department of Nursing Science, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Int J Nurs Stud. 2010 Jun;47(6):671-7. doi: 10.1016/j.ijnurstu.2009.11.005. Epub 2009 Dec 8.
The application of standardized pressure ulcer risk assessment scales is recommended in clinical practice.
The aims of this study were to compare the interrater reliabilities of the Braden and Waterlow scores and subjective pressure ulcer risk assessment and to determine the construct validity of these three assessment approaches.
Observational.
Two intensive care units of a large University Hospital in Germany.
21 and 24 patients were assessed by 53 nurses. Patients' mean age was 69.7 (SD 8.3) and 67.2 (SD 11.3).
Two interrater reliability studies were conducted. Samples of patients were assessed independently by a sample of three nurses. A 10-cm visual analogue scale was applied to measure subjective pressure ulcer risk rating. Intraclass correlation coefficients (ICC) and standard errors of measurement (SEM) were used to determine interrater reliability and agreement of the item and sum scores. Pearson product moment correlation coefficients (r) were used to indicate the degree and direction of the relationships between the measures.
The interrater reliability for the subjective pressure ulcer risk assessment was ICC(1,1)=0.51 (95% CI 0.26-0.74) and 0.71 (95% CI 0.53-0.85). Interrater reliability of Braden scale sum scores was ICC(1,1)=0.72 (95% CI 0.52-0.87) and 0.84 (95% CI 0.72-0.92) and for Waterlow scale sum scores ICC(1,1)=0.36 (95% CI 0.09-0.63) and 0.51 (95% CI 0.27-0.72). The absolute degree of correlation between the measures ranged from 0.51 to 0.77.
Interrater reliability coefficients indicate a high degree of measurement error inherent in the scores. Compared to subjective risk assessment and the Waterlow scale scores the Braden scale performed best. However, measurement error is too high to draw valid inferences for individuals. Less than 26-59% of variances in scores of one scale were determined by scores of another scale indicating that all three instruments only partly measured the same construct. The use of the Braden-, Waterlow- and Visual Analogue scales for measuring pressure ulcer risk of intensive care unit patients is not recommended.
临床实践中推荐使用标准化压疮风险评估量表。
本研究旨在比较Braden 量表和 Waterlow 量表及主观压疮风险评估的评分者间信度，并确定这三种评估方法的结构效度。
观察性研究。
德国一家大型大学医院的两个重症监护病房。
53 名护士评估了 21 名和 24 名患者。患者的平均年龄为 69.7（SD 8.3）和 67.2（SD 11.3）岁。
进行了两项评分者间信度研究。将患者样本由三名护士中的一名进行独立评估。使用 10cm 视觉模拟评分法（VAS）来测量主观压疮风险评分。采用组内相关系数（ICC）和测量标准误差（SEM）来确定评分者间信度和项目及总分的一致性。采用皮尔逊积差相关系数（r）来表示各测量指标间的程度和方向关系。
主观压疮风险评估的评分者间信度 ICC（1,1）为 0.51（95%CI 0.26-0.74）和 0.71（95%CI 0.53-0.85）。Braden 量表总分的评分者间信度 ICC（1,1）为 0.72（95%CI 0.52-0.87）和 0.84（95%CI 0.72-0.92），Waterlow 量表总分的 ICC（1,1）为 0.36（95%CI 0.09-0.63）和 0.51（95%CI 0.27-0.72）。各测量指标间的绝对相关程度范围为 0.51-0.77。
评分者间信度系数表明评分中存在高度的测量误差。与主观风险评估和 Waterlow 量表评分相比，Braden 量表表现最佳。然而，测量误差过高，无法对个体进行有效的推断。一个量表的评分只能解释另一个量表评分变异的 26%-59%，表明这三种工具仅部分测量了相同的结构。因此，不推荐使用 Braden 量表、Waterlow 量表和视觉模拟评分法来测量重症监护病房患者的压疮风险。
