He Wei, Liu Peng, Chen Hong-Lin
School of Nursing, Nantong University, Nantong, Jiangsu PR China.
Ostomy Wound Manage. 2012 Feb;58(2):34-40.
The validity and reliability of the Braden Scale for pressure ulcer development has been established in a variety of patient care settings, but studies suggest the scale does not capture risk factors in surgical patients. The purpose of this metaanalysis was to assess the predictive validity of the Braden Scale for pressure ulcer development in surgical patients. A literature search using PubMed and Web of Science databases (through July 2011) was conducted to identify all clinical studies on predicting pressure ulcers in surgical patients using the Braden Scale. To be eligible for inclusion, studies had to include sensitivity (true positive rate, TPR) and specificity (true negative rate, TNR) results or include sufficient data to calculate these factors. Study quality was assessed using the 14-item Quality Assessment of Diagnostic Accuracy Studies (QUADAS) instrument, and two-by-two tables of predictive validity were constructed from each article. Meta-analysis for predictive validity was performed, including calculation of pooled sensitivity, pooled specificity, diagnostic odds ratio (DOR), construction of summary receiver operating characteristic (SROC) curves, and overall diagnostic accuracy (Q*). Three studies (N = 609 patients) met the meta-analysis inclusion criteria. The pooled estimates for sensitivity and specificity were 0.42 (95% CI: 0.38 to 0.47) and 0.84 (95% CI: 0. 83 to 0.85), respectively, yielding a combined DOR of 4.40 (95% CI: 2.98 to 6.50). The area under the ROC curve (AUC) was 0.6921 ± 0.0346, and the Q* was 0.6466 ± 0.0274. Significant heterogeneity was noted between the included studies with Q value 34.49 (P = 0.0321), and I2 for pooled sensitivity, pooled specificity, and pooled DOR was 88.7%, 98.6%, and 39.1%, respectively. Although the observed heterogeneity between studies may have affected the results, the low values for overall diagnostic accuracy (Q*) and diagnostic capability (AUC) indicate the Braden Scale has low predictive validity for pressure ulcer risk in surgical patients. A new pressure ulcer risk assessment scale for surgical patients should be developed and tested.
压疮发生风险的Braden量表的有效性和可靠性已在多种患者护理环境中得到确立，但研究表明该量表未涵盖外科手术患者的风险因素。本荟萃分析的目的是评估Braden量表对手术患者压疮发生风险的预测效度。通过使用PubMed和科学网数据库（截至2011年7月）进行文献检索，以识别所有使用Braden量表预测手术患者压疮的临床研究。要符合纳入标准，研究必须包括敏感度（真阳性率，TPR）和特异度（真阴性率，TNR）结果，或包含足以计算这些因素的数据。使用14项诊断准确性研究质量评估（QUADAS）工具评估研究质量，并从每篇文章构建预测效度的二乘二表。进行预测效度的荟萃分析，包括计算合并敏感度、合并特异度、诊断比值比（DOR）、构建汇总受试者工作特征（SROC）曲线以及总体诊断准确性（Q*）。三项研究（N = 609例患者）符合荟萃分析纳入标准。敏感度和特异度的合并估计值分别为0.42（95%CI：0.38至0.47）和0.84（95%CI：0.83至0.85），合并DOR为4.40（95%CI：2.98至6.50）。ROC曲线下面积（AUC）为0.6921±0.0346，Q为0.6466±0.0274。纳入研究之间存在显著异质性，Q值为34.49（P = 0.0321），合并敏感度、合并特异度和合并DOR的I2分别为88.7%、98.6%和39.1%。尽管研究之间观察到的异质性可能影响了结果，但总体诊断准确性（Q）和诊断能力（AUC）的低值表明Braden量表对手术患者压疮风险的预测效度较低。应开发并测试一种新的手术患者压疮风险评估量表。
