Roca-Biosca A, Rubio-Rico L, Fernández M I de Molina, Grau N García, Garijo G Tuset, Fernández F P García
Faculty of Nursing, Universidad Rovira i Virgili, Tarragona, Spain.
Hospital Joan XXIII, Tarragona, Spain.
J Wound Care. 2017 Sep 2;26(9):528-536. doi: 10.12968/jowc.2017.26.9.528.
In 2014, a new theoretical model explained the mechanism of the development of pressure ulcers (PUs) and that of seven types of lesions known as dependence-related lesions (DRL). The aim of this study was to calculate the incidence of DRL that have been classified as PUs and to check the predictive validity of the Braden scale for assessing DRL in accordance with the new theoretical model in an intensive care unit (ICU). Method This longitudinal, prospective study was conducted in a Spanish ICU. The patients were monitored for 14 days in the ICU until they developed DRL, died, or were discharged. The patients' risk of developing DRL was assessed each day using the Braden scale. The following parameters were taken as reference for validating the scale: sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), relative risk (RR) and the area under the receiver operating characteristic (ROC) curve.
Of the 295 patients included in the study, 27.5% developed DRL, which 50.6% were categorised as PUs, 17.3% caused by moisture, and 13.6% caused by friction. The rest were categorised as caused by a combination of factors. Risk according to the Braden scale was greater in the group of patients with DRL than in the group of patients without. The highest risk score provided the best predictive validity parameters for the DRL (Se 0.90, Sp 0.26, PPV 0.31, NPV 0.78 and RR 3.15 [confidence interval (CI) 95%: 1.42-6.96]). These vaules show the individuals at risk are well detected, although it is at the expense of generating a number of false positive cases.
The Braden scale has demonstrated a moderate capacity for predicting PUs and DRL caused by moisture, but no capacity for predicting DRL caused by friction.
2014年，一种新的理论模型解释了压疮（PU）以及七种被称为依赖相关损伤（DRL）的损伤类型的发生机制。本研究的目的是计算已被归类为压疮的DRL的发生率，并根据新的理论模型，在重症监护病房（ICU）中检验Braden量表评估DRL的预测效度。方法：这项纵向、前瞻性研究在西班牙的一家ICU进行。对患者在ICU中进行14天的监测，直至其发生DRL、死亡或出院。每天使用Braden量表评估患者发生DRL的风险。采用以下参数来验证该量表：敏感度（Se）、特异度（Sp）、阳性和阴性预测值（分别为PPV和NPV）、相对风险（RR）以及受试者工作特征（ROC）曲线下面积。
在纳入研究的295例患者中，27.5%发生了DRL，其中50.6%被归类为压疮，17.3%由潮湿引起，13.6%由摩擦引起。其余被归类为由多种因素共同导致。发生DRL的患者组根据Braden量表得出的风险高于未发生DRL的患者组。最高风险评分对DRL提供了最佳的预测效度参数（Se 0.90，Sp 0.26，PPV 0.31，NPV 0.78，RR 3.15 [95%置信区间（CI）：1.42 - 6.96]）。这些值表明，虽然以产生一些假阳性病例为代价，但有风险的个体能被很好地检测出来。
Braden量表已证明对预测压疮和由潮湿引起的DRL有一定能力，但对预测由摩擦引起的DRL没有能力。
