Miller Natasha, Frankenfield David, Lehman Erik, Maguire Melissa, Schirm Victoria
Natasha Miller, MSN, RN, CCRN, CWOCN, Penn State Hershey Medical Center, Hershey, Pennsylvania. David Frankenfield, MS, RD, Penn State Hershey Medical Center, Hershey, Pennsylvania. Erik Lehman, MS, Department of Public Health Sciences, College of Medicine Penn State University, Hershey, Pennsylvania. Melissa Maguire, BSN, RN-BC, Penn State Hershey Medical Center, Hershey, Pennsylvania. Victoria Schirm, PhD, RN, Penn State Hershey Medical Center, Hershey, Pennsylvania.
J Wound Ostomy Continence Nurs. 2016 Mar-Apr;43(2):133-9. doi: 10.1097/WON.0000000000000184.
Accurate patient assessment and screening for pressure ulcer (PU) is difficult in the clinical setting, and evaluation of nutritional status is especially problematic. The aim of this retrospective study was to determine the extent to which Braden Scale scores and other nutrition screening parameters (body mass index, poor intake, and weight loss) predict PU development in general and heel and sacral ulcers specifically.
Records of 230 hospitalized patients who developed PU were compared to a matched control group without PU. Logistic regression was used to determine the association of total Braden scores, Braden nutrition subscale scores, and nutrition factors with PU development at any time, within week 1, or within week 2 of hospitalization; and development of sacral and heel ulcers at these same periods.
Braden Scale scores on hospital admission were predictive of hospital-acquired pressure ulcer development at some point during the hospital stay; and more specifically Braden scores on day 7 were predictive of PU development within week 2 of hospitalization. Among nutrition screening factors and PU development, a low body mass index showed a statistically significant relationship with sacral ulcer development.
Findings indicate that the overall Braden score is a valid predictor of PU development. Implications for clinical practice to decrease the risk for PU development include appropriate use of reliable and valid scales by nurses along with careful evaluation of nutrition parameters.
在临床环境中，准确评估患者并筛查压疮（PU）存在困难，尤其是营养状况评估问题较大。这项回顾性研究的目的是确定Braden量表评分以及其他营养筛查参数（体重指数、摄入不足和体重减轻）在总体上以及具体针对足跟和骶骨溃疡预测PU发生的程度。
将230例发生PU的住院患者的记录与未发生PU的匹配对照组进行比较。采用逻辑回归分析来确定Braden总分、Braden营养子量表评分以及营养因素与住院期间任何时间、住院第1周内或第2周内PU发生之间的关联；以及在相同时间段内骶骨和足跟溃疡的发生情况。
入院时的Braden量表评分可预测住院期间某个时间点发生的医院获得性压疮；更具体地说，第7天的Braden评分可预测住院第2周内PU的发生。在营养筛查因素与PU发生之间，低体重指数与骶骨溃疡发生存在统计学显著关系。
研究结果表明，Braden总分是PU发生的有效预测指标。临床实践中降低PU发生风险的意义包括护士合理使用可靠有效的量表以及仔细评估营养参数。
