Quality Management, Charité Universitätsmedizin Berlin, Berlin, Germany.
Int J Nurs Stud. 2013 Jun;50(6):807-18. doi: 10.1016/j.ijnurstu.2011.04.014. Epub 2011 Jun 8.
Pressure ulcer risk assessment using an age-appropriate, valid and reliable tool is recommended for clinical paediatric practice.
(1) What PU risk scales for children currently exist? (2) What is the diagnostic accuracy of their scores? (3) Are the scores reliable and what is the degree of agreement? (4) What is the clinical impact of risk scale scores in paediatric practice?
Systematic review.
MEDLINE (1950 to December 2010), EMBASE (1989 to December 2010), CINAHL (1982 to December 2010), reference lists.
Two reviewers independently screened databases, selected and evaluated articles and studies. Diagnostic accuracy, reliability/agreement, and experimental studies investigating the performance and clinical impact of PU risk scale scores in the paediatric population (0-18 years) were included. PU development was used as reference standard for diagnostic accuracy studies. Methodological quality of the validity and reliability studies was assessed based on the QUADAS and QAREL checklists.
The search yielded 1141 hints. Finally, 15 publications describing or applying 12 paediatric pressure ulcer risk scales were included. Three of these scales (Neonatal Skin Risk Assessment Scale for Predicting Skin Breakdown, Braden Q Scale, Burn Pressure Skin Risk Assessment Scale) were investigated in prospective validation studies. Empirical evidence about interrater reliability and agreement is available for four instruments (Neonatal Skin Risk Assessment Scale for Predicting Skin Breakdown, Starkid Skin Scale, Glamorgan Scale, Burn Pressure Ulcer Risk Assessment Scale). No studies were identified investigating the clinical impact.
Sound empirical evidence about the performance of paediatric pressure ulcer risk assessment scales is lacking. Based on the few results of this review no instrument can be regarded as superior to the others. Whether the application of pressure ulcer risk assessment scales reduces the pressure ulcer incidence in paediatric practice is unknown. Maybe clinical judgement is more efficient in evaluating pressure ulcer risk than the application of risk scale scores.
推荐在临床儿科实践中使用适合年龄、有效且可靠的工具进行压疮风险评估。
（1）目前有哪些针对儿童的压疮风险评估量表？（2）其评分的诊断准确性如何？（3）评分是否可靠，其一致性程度如何？（4）在儿科实践中，风险评估量表评分的临床影响如何？
系统评价。
MEDLINE（1950 年至 2010 年 12 月）、EMBASE（1989 年至 2010 年 12 月）、CINAHL（1982 年至 2010 年 12 月）、参考文献列表。
两位审查员独立筛选数据库、选择和评估文章和研究。纳入了针对儿科人群（0-18 岁）的压疮风险评估量表的性能和临床影响的诊断准确性、可靠性/一致性以及实验研究。将压疮发生作为诊断准确性研究的参考标准。基于 QUADAS 和 QAREL 清单评估有效性和可靠性研究的方法学质量。
检索到 1141 个提示。最终，纳入了 15 项描述或应用 12 种儿科压疮风险评估量表的研究。其中 3 种量表（用于预测皮肤破裂的新生儿皮肤风险评估量表、Braden Q 量表、烧伤压力皮肤风险评估量表）进行了前瞻性验证研究。有 4 种工具（用于预测皮肤破裂的新生儿皮肤风险评估量表、Starkid 皮肤量表、Glamorgan 量表、烧伤压力性溃疡风险评估量表）具有关于评分者间可靠性和一致性的实证证据。未发现研究压力评估量表对临床的影响。
关于儿科压疮风险评估量表性能的可靠实证证据不足。基于本次综述的少数结果，无法认为任何一种工具优于其他工具。在儿科实践中应用压疮风险评估量表是否能降低压疮发生率尚不清楚。也许临床判断在评估压疮风险方面比应用风险评分更有效。
