Parker Christina N, Finlayson Kathleen J, Edwards Helen E
Ostomy Wound Manage. 2017 Oct;63(10):16-33.
Venous leg ulcers are characterized by a long healing process and repeated cycles of ulceration. A secondary analysis of data from multisite longitudinal studies was conducted to identify risk factors for delayed healing and recurrence of venous leg ulcers for development of risk assessment tools, and a single-site prospective study was performed to as- sess the new tools' interrater reliability (IRR). The development of the risk assessment tools was based on results from previous multivariate analyses combined with further risk factors documented in the literature from systematic reviews, randomized controlled trials, and cohort studies with regard to delayed healing and recurrence. The delayed healing tool contained 10 items, including patient demographics, living status, use of high-compression therapy, ulcer area, wound bed tissue type, and percent reduction in ulcer area after 2 weeks. The recurrence tool included 8 items, including his- tory of deep vein thrombosis, duration of previous ulcer, history of previous ulcers, body mass index, living alone, leg elevation, walking, and compression. Using consensus procedures, content validity was established by an advisory group of 21 expert multidisciplinary clinicians and researchers. To determine intraclass correlation (ICC) and IRR, 3 rat- ers assessed 26 patients with an open ulcer and 22 with a healed ulcer. IRR analysis indicated statistically signi cant agreement for the delayed healing tool (ICC 0.84; 95% con dence interval [CI], 0.70-0.92; P <.001) and the recurrence tool (ICC 0.88; 95% CI, 0.75-0.94; P <.001). The development and reliability results of these risk assessment tools meet the recommendations for evidence-based, reliable tools and may bene t clinicians and patients in the management of venous leg ulcers. Studies to examine the items with low ICC scores and to determine the predictive validity of these tools are warranted.
下肢静脉溃疡的特点是愈合过程漫长且溃疡反复发作。为了开发风险评估工具，对多中心纵向研究的数据进行了二次分析，以确定下肢静脉溃疡延迟愈合和复发的风险因素，并进行了一项单中心前瞻性研究，以评估新工具的评分者间信度（IRR）。风险评估工具的开发基于先前多变量分析的结果，并结合了系统评价、随机对照试验和队列研究文献中记录的关于延迟愈合和复发的进一步风险因素。延迟愈合工具包含10项内容，包括患者人口统计学特征、生活状况、高压力治疗的使用、溃疡面积、伤口床组织类型以及2周后溃疡面积的缩小百分比。复发工具包括8项内容，包括深静脉血栓形成病史、既往溃疡持续时间、既往溃疡病史、体重指数、独居、腿部抬高、行走和压力治疗。通过由21名多学科临床专家和研究人员组成的咨询小组采用共识程序确定了内容效度。为了确定组内相关系数（ICC）和IRR，3名评分者对26例开放性溃疡患者和22例已愈合溃疡患者进行了评估。IRR分析表明，延迟愈合工具（ICC 0.84；95%置信区间[CI]，0.70 - 0.92；P <.001）和复发工具（ICC 0.88；95%CI，0.75 - 0.94；P <.001）在统计学上具有显著一致性。这些风险评估工具的开发和信度结果符合基于证据的可靠工具的建议，可能会使临床医生和患者在下肢静脉溃疡的管理中受益。有必要开展研究来检查ICC评分较低的项目，并确定这些工具的预测效度。
