Hu Ya-Han, Lee Yi-Lien, Kang Ming-Feng, Lee Pei-Ju
Author Affiliations: Department of Information Management, National Central University, Taoyuan, Taiwan (Dr Hu); Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Chiayi, Taiwan (Dr Hu); MOST AI Biomedical Research Center, National Cheng Kung University, Tainan, Taiwan (Dr Hu); Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, Chiayi, Taiwan (Ms Lee, Ms Kang, and Dr Lee); Department of Medical Affairs, Chi Mei Medical Center, Tainan, Taiwan (Ms Lee); and Office of Resource Management, St. Martin De Porres Hospital, Chiayi, Taiwan (Ms Kang).
Comput Inform Nurs. 2020 Aug;38(8):415-423. doi: 10.1097/CIN.0000000000000604.
The incidence rate of pressure injury is a critical nursing quality indicator in clinic care; consequently, factors causing pressure injury are diverse and complex. The early prevention of pressure injury and monitoring of these complex high-risk factors are critical to reduce the patients' pain, prevent further surgical treatment, avoid prolonged hospital stay, decrease the risk of wound infection, and lower associated medical costs and expenses. Although a number of risk assessment scales of pressure injury have been adopted in various countries, their criteria are set for specific populations, which may not be suitable for the medical care systems of other countries. This study constructs three prediction models of inpatient pressure injury using machine learning techniques, including decision tree, logistic regression, and random forest. A total of 11 838 inpatient records were collected, and 30 sets of training samples were adopted for data analysis in the experiment. The experimental results and evaluations of the models suggest that the prediction model built using random forest had most favorable classification performance of 0.845. The critical risk factors for pressure injury identified in this study were skin integrity, systolic blood pressure, expression ability, capillary refill time, and level of consciousness.
压疮发生率是临床护理中一项关键的护理质量指标;因此,导致压疮的因素多样且复杂。压疮的早期预防以及对这些复杂高危因素的监测对于减轻患者痛苦、避免进一步手术治疗、防止住院时间延长、降低伤口感染风险以及减少相关医疗成本和费用至关重要。尽管各国已采用多种压疮风险评估量表,但其标准是针对特定人群设定的,可能不适用于其他国家的医疗体系。本研究利用机器学习技术构建了三种住院患者压疮预测模型,包括决策树、逻辑回归和随机森林。共收集了11838份住院患者记录,并采用30组训练样本进行实验数据分析。模型的实验结果和评估表明,使用随机森林构建的预测模型具有最有利的分类性能,为0.845。本研究确定的压疮关键危险因素为皮肤完整性、收缩压、表达能力、毛细血管再充盈时间和意识水平。