Institut für Medizin-/Pflegepädagogik und Pflegewissenschaft, Department of Nursing Science, Charité- Universitätsmedizin Berlin, Berlin, Germany.
J Clin Nurs. 2012 Feb;21(3-4):354-61. doi: 10.1111/j.1365-2702.2010.03550.x. Epub 2011 Mar 9.
The objective of the study was to evaluate the effect of being treated in intensive care units in comparison with general hospital wards regarding pressure ulcer occurrence when controlled for various risk factors.
Pressure ulcer occurrence is commonly used as an indicator for the quality of care. Large-scale incidence studies are costly and difficult to perform.
Secondary analysis of patient data (n = 32,400) collected during 2002-2009 as part of eight multicentre pressure ulcer surveys in 256 German hospitals.
Ward-acquired pressure ulcer rate was used for the calculation of effect sizes as a surrogate parameter for pressure ulcer incidence. The SRISAG (surface, repositioning, immobility, shear forces, age, gender) logistic regression model was used to control for differences in case mix.
Pressure ulcer prevention and intrinsic and extrinsic risk factors differ for patients from hospital wards compared with those from intensive care wards. The ward-acquired pressure ulcer rate in general hospital wards was 3·9% (1·5% excluding grade 1). In intensive care, the rate was 14·9% (8·5% excluding grade 1), which corresponds with an unadjusted odds ratio of 4·3 (95%CI 3·8-4·9). After the SRISAG model was applied, the odds ratio was reduced to 1·5 (CI 1·2-1·7).
When surface, repositioning, immobility, shear forces, age and gender are controlled for the institutional factor intensive care unit vs. general hospital wards is no longer a high-risk factor for the development of pressure ulcer. The SRISAG model is simple and can be used to compare the occurrence of pressure ulcer between different medical specialties.
Application of this model allows more valuable comparison of the occurrence of pressure ulcer in different specialities and enables clinical practitioners and health care planners to use this outcome as an indicator for the quality of care to avoid confounding.
本研究旨在评估与普通病房相比，在控制各种危险因素后，患者入住重症监护病房对压疮发生的影响。
压疮的发生通常被用作护理质量的指标。大规模的发病研究既昂贵又难以进行。
对 2002-2009 年期间作为 256 家德国医院的八项多中心压疮调查的一部分收集的患者数据（n=32400）进行二次分析。
使用病房获得性压疮率作为替代指标计算压疮发生率的效应大小。使用 SRISAG（表面、翻身、固定、剪切力、年龄、性别）逻辑回归模型来控制病例组合的差异。
与重症监护病房患者相比，普通病房患者的压疮预防和内在及外在危险因素不同。普通病房的病房获得性压疮率为 3.9%（不包括 1 级的压疮率为 1.5%）。而在重症监护病房，这一比率为 14.9%（不包括 1 级的压疮率为 8.5%），这对应于未调整的比值比为 4.3（95%CI 3.8-4.9）。在应用 SRISAG 模型后，比值比降低至 1.5（95%CI 1.2-1.7）。
当控制了机构因素（重症监护病房与普通病房）后，表面、翻身、固定、剪切力、年龄和性别，重症监护病房不再是压疮发展的高风险因素。SRISAG 模型简单，可用于比较不同医学专业之间压疮的发生情况。
应用该模型可以更有价值地比较不同专业之间压疮的发生情况，并使临床医生和医疗保健规划者能够将该结果作为护理质量的指标，以避免混杂因素。
