Br J Surg. 2019 Feb;106(3):226-235. doi: 10.1002/bjs.11008. Epub 2018 Dec 17.
Accurate assessment of surgical-site infection (SSI) is crucial for surveillance and research. Self-reporting patient measures are needed because current SSI tools are limited for assessing patients after leaving hospital. The Bluebelle Wound Healing Questionnaire (WHQ) was developed for patient or observer completion; this study tested its acceptability, scale structure, reliability and validity in patients with closed primary wounds after abdominal surgery.
Patients completed the WHQ (self-assessment) within 30 days after leaving hospital and returned it by post. Healthcare professionals completed the WHQ (observer assessment) by telephone or face-to-face. Questionnaire response rates and patient acceptability were assessed. Factor analysis and Cronbach's α examined scale structure and internal consistency. Test-retest and self- versus observer reliability assessments were performed. Sensitivity and specificity for SSI discrimination against a face-to-face reference diagnosis (using Centers for Disease Control and Prevention criteria) were examined.
Some 561 of 792 self-assessments (70·8 per cent) and 597 of 791 observer assessments (75·5 per cent) were completed, with few missing data or problems reported. Data supported a single-scale structure with strong internal consistency (α greater than 0·8). Reliability between test-retest and self- versus observer assessments was good (κ 0·6 or above for the majority of items). Sensitivity and specificity for SSI discrimination was high (area under the receiver operating characteristic (ROC) curve 0·91).
The Bluebelle WHQ is acceptable, reliable and valid with a single-scale structure for postdischarge patient or observer assessment of SSI in closed primary wounds.
准确评估手术部位感染（SSI）对于监测和研究至关重要。由于目前的 SSI 工具在患者出院后评估患者时存在局限性，因此需要进行自我报告的患者测量。Bluebelle 伤口愈合问卷（WHQ）是为患者或观察者完成而开发的；本研究测试了其在腹部手术后闭合性原发性伤口患者中的可接受性、量表结构、可靠性和有效性。
患者在出院后 30 天内完成 WHQ（自我评估），并通过邮寄方式返回。医疗保健专业人员通过电话或面对面方式完成 WHQ（观察者评估）。评估问卷的回复率和患者的可接受性。因子分析和 Cronbach's α 检验量表结构和内部一致性。进行测试-重测和自我-与观察者之间的可靠性评估。使用疾病预防控制中心的标准，对面诊参考诊断（使用疾病预防控制中心的标准）对 SSI 进行区分的敏感性和特异性进行了检查。
在 792 次自我评估中，有 561 次（70.8%）和在 791 次观察者评估中，有 597 次（75.5%）完成了评估，且报告的缺失数据或问题很少。数据支持具有较强内部一致性（α 值大于 0.8）的单一量表结构。测试-重测和自我-与观察者评估之间的可靠性良好（大多数项目的κ 值大于 0.6）。对 SSI 区分的敏感性和特异性较高（接收者操作特征（ROC）曲线下面积 0.91）。
Bluebelle WHQ 具有可接受性、可靠性和有效性，具有单一量表结构，可用于出院后患者或观察者对闭合性原发性伤口 SSI 的评估。
