El-Daly Ibraheim, Ibraheim Hajir, Culpan Paul, Bates Peter
The Royal London Hospital, Barts Health NHS Trust, Department of Trauma and Orthopaedic Surgery, Whitechapel, London E1 1BB, United Kingdom.
The Royal London Hospital, Barts Health NHS Trust, Department of Trauma and Orthopaedic Surgery, Whitechapel, London E1 1BB, United Kingdom.
Injury. 2015 Dec;46(12):2394-8. doi: 10.1016/j.injury.2015.09.034. Epub 2015 Oct 8.
Nursing staff prospectively collect Waterlow scores (Ws) on all inpatients across most NHS hospitals, identifying patients at risk of pressure ulcers. This bedside score has not been applied in predicting other negative outcomes in patients with neck of femur (NOF) fractures.
To investigate the relationship between increasing Waterlow score and 30-day post-operative infection in patients with NOF fracture.
Pre-operative Ws and 30-day clinical outcome data were collected on 97 consecutive operatively treated NOF fracture patients at our institution (level one trauma centre).
30-day infection rate was 36%, which manifested as hospital acquired pneumonia (66%) and urinary tract infection (34%). For every one point increase in Ws, the odds of having an infection increased by 1.68 times (95% CI 1.37-2.08). The relationship between Ws and 30-day infection was similar when adjusted for potential confounders: patient demographics (age and gender), number of medical comorbidities, ASA grade, and days to surgery. For our data, the Ws predictive of infection was ≥17. This has a sensitivity of 84.9% (95% CI 68.1-94.9%) and a specificity of 84.1% (95% CI 74.7-92.1%). The area under the curve was 0.89 (95% CI 0.82-0.96).
Our study demonstrates a strong relationship between increasing Ws and post-operative infection risk. This raises the interesting yet controversial question of using Ws to identify patients at high-risk of developing post-operative infections and the potential benefit of an extended period of antibiotic prophylaxis.
在大多数国民保健制度（NHS）医院中，护理人员会前瞻性地收集所有住院患者的沃特洛评分（Ws），以识别有压疮风险的患者。该床边评分尚未应用于预测股骨颈（NOF）骨折患者的其他不良结局。
研究沃特洛评分升高与NOF骨折患者术后30天感染之间的关系。
收集了我们机构（一级创伤中心）97例接受手术治疗的连续性NOF骨折患者的术前Ws和30天临床结局数据。
30天感染率为36%，表现为医院获得性肺炎（66%）和尿路感染（34%）。Ws每增加1分，感染几率增加1.68倍（95%置信区间1.37 - 2.08）。在对潜在混杂因素（患者人口统计学特征（年龄和性别）、内科合并症数量、美国麻醉医师协会（ASA）分级和手术天数）进行调整后，Ws与30天感染之间的关系相似。对于我们的数据，预测感染的Ws≥17。其敏感性为84.9%（95%置信区间68.1 - 94.9%），特异性为84.1%（95%置信区间74.7 - 92.1%）。曲线下面积为0.89（95%置信区间0.82 - 0.96）。
我们的研究表明，Ws升高与术后感染风险之间存在密切关系。这提出了一个有趣但有争议的问题，即使用Ws识别术后感染高风险患者以及延长抗生素预防时间的潜在益处。
