Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
Wound Care Center, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
Nurs Crit Care. 2020 May;25(3):165-170. doi: 10.1111/nicc.12500. Epub 2020 Jan 27.
Pressure ulcers (PUs) are encountered in all types of care settings. The incidence of PUs in the intensive care unit (ICU) is higher for a variety of reasons. The Braden Scale is a widely used tool to assess the risk of PU, but its predictive power is controversial in ICU settings. In this systematic review and meta-analysis, we aimed to evaluate the predictive accuracy of the Braden Scale for measurement of risk of PU in adult ICU patients.
A comprehensive literature search in English databases (PubMed, Cochrane Library, OVID, and Web of Science), Chinese databases (SinoMed, CNKI, and Wanfang), and gray literature was performed. Studies assessing the predictive value of the Braden Scale for risk of PU in adult ICU patients were searched. Quality of the studies was scored with Quality Assessment of Diagnostic Accuracy Studies-2. Country, study design, setting, blinding, and characteristics of included studies were extracted.
Eleven full-text articles containing 10 044 patients, comprising 1058 patients with PUs were included. The pooled sensitivity and specificity of the Braden Scale for predicting PU risk in ICU adults were 0.89 (95% CI, 0.87-0.91; I = 94.9%, P = .0000) and 0.28 (95% CI, 0.27-0.29; I = 99.2%, P = .0000), respectively. The pooled DOR was 6.29 (95% CI: 4.09-9.68). The overall weighted AUC was 0.7812 ± 0.0331 (95% CI: 0.7163-0.8461) and the Q* value was 0.7196 ± 0.0283 (95% CI: 0.6641-0.7751). Significant heterogeneity was noted among the included studies. Meta-regression analysis showed that there was no heterogeneity in blinding (P = .074), study design (P = .679), or cut-off value (P = .821).
This meta-analysis demonstrated that the Braden Scale had a moderate predictive validity with good sensitivity and low specificity in adult critically ill patients. Further development and modification of this tool or generation of a new tool with higher predictive power is warranted for use in ICU populations.
The first step in prevention of PU is risk assessment. In this meta-analysis, we aimed to evaluate the predictive power of the Braden Scale for assessing risk of PU in ICU adult patients, which could potentially guide clinical practice.
压力性溃疡（PU）可见于各类医疗护理环境中。由于多种原因，重症监护病房（ICU）的 PU 发生率更高。Braden 量表是一种广泛用于评估 PU 风险的工具，但在 ICU 环境中的预测能力存在争议。在本次系统评价和荟萃分析中，我们旨在评估 Braden 量表评估成人 ICU 患者 PU 风险的预测准确性。
对英文数据库（PubMed、Cochrane 图书馆、OVID 和 Web of Science）、中文数据库（SinoMed、CNKI 和万方）和灰色文献进行全面文献检索，以检索评估成人 ICU 患者 Braden 量表评估 PU 风险的预测价值的研究。使用诊断准确性研究质量评估-2 对研究的质量进行评分。提取研究的国家、研究设计、设置、盲法和纳入研究的特征。
共纳入 11 篇全文文章，包含 10044 例患者，其中 1058 例患者患有 PU。Braden 量表预测 ICU 成人 PU 风险的敏感性和特异性的汇总值分别为 0.89（95%CI，0.87-0.91；I = 94.9%，P =.0000）和 0.28（95%CI，0.27-0.29；I = 99.2%，P =.0000）。汇总的 DOR 为 6.29（95%CI：4.09-9.68）。总体加权 AUC 为 0.7812±0.0331（95%CI：0.7163-0.8461），Q* 值为 0.7196±0.0283（95%CI：0.6641-0.7751）。纳入研究存在显著的异质性。元回归分析显示，盲法（P =.074）、研究设计（P =.679）或截断值（P =.821）方面均无异质性。
本次荟萃分析表明，Braden 量表在评估 ICU 成年危重症患者的风险方面具有中等预测准确性，敏感性好，特异性低。需要进一步开发和改进该工具，或开发预测能力更高的新工具，以便在 ICU 人群中使用。
预防 PU 的第一步是风险评估。在本次荟萃分析中，我们旨在评估 Braden 量表评估 ICU 成年患者发生 PU 风险的预测能力，这可能有助于指导临床实践。
