Moyse Tonya, Bates Jacqueline, Karafa Matthew, Whitman Angela, Albert Nancy M
Tonya Moyse, BSN, RN, Vascular Surgery Progressive-Care Unit, Cleveland Clinic, Cleveland, Ohio.Jacqueline Bates, MSN, RN, CMSRN, NE-BC, Post-Anesthesia Care Unit, Cleveland Clinic, Cleveland, Ohio.Matthew Karafa, PhD, Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.Angela Whitman, BSN, RN, Vascular Surgery Progressive-Care Unit, Cleveland Clinic, Cleveland, Ohio.Nancy M. Albert, PhD, CCNS, CHFN, CCRN, FCCM, FAHA, FAAN, Nursing Research and Innovation, Cleveland Clinic, Cleveland, Ohio.
J Wound Ostomy Continence Nurs. 2017 Mar/Apr;44(2):118-122. doi: 10.1097/WON.0000000000000305.
The purpose of this study was to validate a 10-factor model of risk factors for hospital-acquired pressure injury (HAPI) risk in patients with vascular disease.
Medical reviews identified 800 patients from a 1063 admissions to a 1400 bed quarternary care hospital in the midwestern United States.
Retrospective review of medical records.
Medical records of consecutive patients treated during an 18-month period on a medical-surgical vascular progressive care unit were reviewed. Ten previously identified risk factors for HAPI-(1) lower right ankle-brachial index, (2) low Braden Scale for Pressure Sore Risk score, (3) cared for in intensive care unit, (4) low serum hematocrit values, (4) elevated serum hematocrit levels (5) female gender, (6) nonwhite individual, (7) atherosclerosis, (8) diabetes mellitus, (9) elevated blood urea nitrogen levels, and (10) high body mass index-were compared to determine their ability to predict development of HAPI. Logistic regression model was used to validate the model.
One hundred forty-six (16.1%) out of 800 patients developed an HAPI. The 10-factor risk model produced a concordance index of predicted to actual risk of 0.851, and the likelihood of developing an HAPI based on the model was significant (P < .001).
A 10-factor model of HAPI risk was developed for patients with vascular disease. Routine assessment of risk factors is crucial in planning individualized interventions to diminish the risk of HAPI occurrences.
本研究旨在验证血管疾病患者医院获得性压力性损伤（HAPI）风险的10因素模型。
通过医学回顾，从美国中西部一家拥有1400张床位的四级医疗医院的1063例入院患者中确定了800例患者。
对病历进行回顾性研究。
回顾了在一个18个月期间，在医疗-外科血管进阶护理病房接受治疗的连续患者的病历。将先前确定的10个HAPI风险因素——（1）右下踝肱指数较低，（2）压力性溃疡风险Braden量表评分较低，（3）在重症监护病房接受护理，（4）血清血细胞比容值较低，（5）血清血细胞比容水平升高，（6）女性，（7）非白人个体，（8）动脉粥样硬化，（9）糖尿病，（10）血尿素氮水平升高，以及（11）高体重指数——进行比较，以确定它们预测HAPI发生的能力。使用逻辑回归模型对该模型进行验证。
800例患者中有146例（占16.1%）发生了HAPI。10因素风险模型预测风险与实际风险的一致性指数为0.851，基于该模型发生HAPI的可能性具有统计学意义（P < .001）。
为血管疾病患者开发了一个HAPI风险的10因素模型。在规划个体化干预措施以降低HAPI发生风险时，对风险因素进行常规评估至关重要。
