St Vincent's Centre for Nursing Research, Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia.
Wound Repair Regen. 2011 Jan-Feb;19(1):31-7. doi: 10.1111/j.1524-475X.2010.00647.x. Epub 2010 Dec 6.
The purpose of this study was to develop and validate a pressure ulcer risk assessment for acute hospitals. This tool was developed in a cohort of 342 patients with a mean age 63 years (SD 19.82) and validated in a second cohort of 165 patients with a mean age 68 years (SD 18.40). Risk factors for inclusion on The Northern Hospital Pressure Ulcer Prevention Plan (TNH-PUPP) were identified from the literature then examined and weighted using logistic regression. Risk factors included on the TNH-PUPP were requires assistance to move in bed (odds ratio [OR] 5.15; 95% confidence interval [CI]: 2.49-10.65), admission to intensive care during current admission (OR 2.98; 95% CI: 1.33-6.67), aged ≥ 65 years (OR 2.81; 95% CI: 1.24-6.36), reduced sensation (OR 2.29; 95% CI: 1.19-4.42), and cognitive impairment (OR 2.26; 95% CI: 1.09-4.67). The TNH-PUPP was validated in a prospective sample. The new tool had high diagnostic validity (area under the receiver operating curve=0.86), consistent in the validation sample (area under the receiver operating curve=0.90). The TNH-PUPP has a moderate positive predictive value (development=0.50; validation=0.13), and a high negative predictive value (development=0.94; validation=0.99) enabling low-risk patients to be screened out, as noncandidates for pressure ulcer prevention interventions. An accurate pressure ulcer risk assessment has been developed and validated, which identifies a high-risk group to whom limited pressure ulcer prevention resources should be directed. The TNH-PUPP facilitates effective resource allocation and is likely to reduce unnecessary patient harm and costs from pressure ulcers in acute hospitals.
本研究旨在开发和验证一种适用于急性医院的压疮风险评估工具。该工具在 342 名平均年龄为 63 岁（标准差 19.82）的患者队列中进行开发，并在 165 名平均年龄为 68 岁（标准差 18.40）的患者队列中进行验证。从文献中确定了纳入《北方医院压疮预防计划》（TNH-PUPP）的危险因素，然后使用逻辑回归进行了检查和加权。纳入 TNH-PUPP 的危险因素包括需要协助在床上移动（优势比[OR]5.15；95%置信区间[CI]：2.49-10.65）、当前入院期间入住重症监护病房（OR 2.98；95% CI：1.33-6.67）、年龄≥65 岁（OR 2.81；95% CI：1.24-6.36）、感觉减退（OR 2.29；95% CI：1.19-4.42）和认知障碍（OR 2.26；95% CI：1.09-4.67）。该工具在前瞻性样本中得到验证。新工具具有较高的诊断准确性（受试者工作特征曲线下面积=0.86），在验证样本中一致（受试者工作特征曲线下面积=0.90）。TNH-PUPP 具有中等阳性预测值（开发=0.50；验证=0.13）和高阴性预测值（开发=0.94；验证=0.99），能够筛选出低风险患者，使他们不适合接受压疮预防干预。已经开发和验证了一种准确的压疮风险评估工具，该工具确定了一个高风险群体，应将有限的压疮预防资源集中在该群体上。TNH-PUPP 有助于有效分配资源，并可能减少急性医院中不必要的患者压疮伤害和成本。
