Ninbanphot Suchada, Narawong Pinyada, Theeranut Ampornpan, Sawanyawisuth Kittisak, Limpawattana Panita
Intensive Care Unit of Internal Medicine, Faculty of Medicine, KhonKaen University, Thailand.
Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
Heliyon. 2020 Aug 19;6(8):e04612. doi: 10.1016/j.heliyon.2020.e04612. eCollection 2020 Aug.
Pressure ulcers (PUs) are one of the quality care indicators in nursing care. They are considered to primarily be preventable. Early identification of the patients most at risk particular for critically ill patients is crucial for providing prompt care. Several tools have been developed to support healthcare providers, but their validities are limited in Thailand. Development of tools with better performance is essential.
To develop and validate a PU risk assessment tool with good diagnostic properties in intensive care units (ICUs).
A prospective study was conducted in ICUs of a tertiary care hospital, Thailand from January 2019 to April 2020. Baseline data were collected at admission to the ICUs. Skin assessment was evaluated every 24 h. Data were divided into two sets: model development and model validation. Creating a risk score which was derived from multivariate methods were performed. Youden index were used to determine the optimal cut-off point. Then, the other dataset was used to validate the risk score. Receiver Operating Characteristic (ROC) curves was used to demonstrate the performance of the test.
The study included 288 and 270 patients for development and validation models. The risk score consisted 4 clinical factors; presence of Cardiovascular disease, low serum Albumin, having Ventilated, and Edema (CAVE score). The area under the ROC curve (AUC) was 0.8 and a score at 2.5 was the best cut-off point. The AUC in the validation group was 0.6, age<60 years was 0.78, and age≥60 years was 0.57.
The predictive validity of the CAVE score is limited but comparable to the existing tools in Thailand. However, it has a good diagnostic property in young patients. The CAVE score could be considered as an alternate screening tool in critical care setting particularly for young patients.
压疮是护理质量指标之一。它们被认为主要是可预防的。早期识别高危患者，尤其是重症患者，对于及时提供护理至关重要。已经开发了几种工具来支持医疗服务提供者，但在泰国其有效性有限。开发性能更好的工具至关重要。
开发并验证一种在重症监护病房（ICU）具有良好诊断性能的压疮风险评估工具。
2019年1月至2020年4月在泰国一家三级护理医院的ICU进行了一项前瞻性研究。在入住ICU时收集基线数据。每24小时评估一次皮肤状况。数据分为两组：模型开发组和模型验证组。采用多变量方法创建风险评分。用约登指数确定最佳截断点。然后，用另一个数据集验证风险评分。采用受试者工作特征（ROC）曲线来展示测试性能。
研究纳入了288例和270例患者用于开发和验证模型。风险评分由4个临床因素组成；心血管疾病、低血清白蛋白、通气和水肿（CAVE评分）。ROC曲线下面积（AUC）为0.8，截断点为2.5时评分最佳。验证组的AUC为0.6，年龄<60岁为0.78，年龄≥60岁为0.57。
CAVE评分的预测效度有限，但与泰国现有的工具相当。然而，它在年轻患者中具有良好的诊断性能。CAVE评分可被视为重症监护环境中的一种替代筛查工具，特别是对于年轻患者。
