Mary Seacole Research Centre, De Montfort University, Leicester LE2 1RQ, UK.
J Tissue Viability. 2010 Nov;19(4):132-6. doi: 10.1016/j.jtv.2009.11.006. Epub 2009 Dec 24.
Risk assessment scales are widely used to measure the risk of pressure ulcers in the clinical area. They have been subject to many validation studies; however these have focused on the predictive ability of the scales. We have conducted several studies that consider the validity of pressure ulcer risk assessment scales. We have reviewed these and revisited the data in some cases to conduct additional tests of validity presented for the first time in this paper. Based on these results, and a review of the literature, we have come to the conclusion that while the scales are probably reliable, and do assess risk: 1. Many of the components of risk assessment scales are not predictive of pressure ulcers. 2. There are other variables that are routinely available to clinicians that give additional predictive power. 3. The importance of components is not accurately reflected by their range of values. 4. Components are correlated and some components may be removed with no loss of predictive power. 5. There is no evidence the use of risk assessment scales reduces pressure ulcer incidence. The complexity of risk assessment scales does not appear to be warranted. There is evidence that clinical judgment is as effective in assessing risk as risk assessment scales. Reduction in pressure ulcer incidence after implementation of risk assessment tools is likely to be an example of the Hawthorn effect. We believe risk assessment scales are useful research tools, but may not be useful in clinical practice.
风险评估量表广泛应用于临床领域，用于测量压疮风险。这些量表已经经过了许多验证研究，但这些研究主要集中在量表的预测能力上。我们进行了多项研究，考虑了压疮风险评估量表的有效性。我们回顾了这些研究，并在某些情况下重新审视了数据，以首次在本文中提出了其他有效性测试。基于这些结果和文献回顾，我们得出结论，虽然这些量表可能是可靠的，并且确实可以评估风险：1. 风险评估量表的许多组成部分并不能预测压疮。2. 还有其他常规提供给临床医生的变量，可以提供额外的预测能力。3. 组成部分的重要性并没有被其数值范围准确反映出来。4. 组成部分是相关的，一些组成部分可以被去除，而不会损失预测能力。5. 没有证据表明使用风险评估量表可以降低压疮的发生率。风险评估量表的复杂性似乎没有得到证实。有证据表明，临床判断在评估风险方面与风险评估量表同样有效。在实施风险评估工具后，压疮发生率的降低可能是霍桑效应的一个例子。我们认为风险评估量表是有用的研究工具，但在临床实践中可能并不实用。
