Harrison M B, Wells G, Fisher A, Prince M
Department of Nursing Research, Loeb Research Institute, Ottawa, Ontario, Canada.
Appl Nurs Res. 1996 Feb;9(1):9-17. doi: 10.1016/s0897-1897(96)80324-7.
Clinical practice guidelines for the prediction and prevention of pressure ulcer (Agency for Health Care Policy and Research [AHCPR], 1992) were evaluated in a Canadian, university-affiliated, acute care hospital. Through a prospective study, the prevalence of pressure ulcers was determined, and pressure ulcer incidence was tracked to evaluate the accuracy of the Braden Scale for risk assessment. The prevalence rate for stage II or greater pressure ulcers was 13.6%; the rate was 29.7% when stage I (persistent redness) was included. In evaluating the Braden Scale's accuracy in predicting risk, the findings from this study were less favorable than previous reports. The total Braden score that appeared to have the best balance of sensitivity (67%) and specificity (66%) was 19. Several factors should be considered: The scale was implemented and tested hospitalwide with a wide range of patient diagnoses, age, and severity; the study was a cross-section of an existing population; and the levels of nursing care and type of staff vary between units ranging from critical to long-term care. This study highlights the need for individual settings to evaluate the AHCPR Guidelines for the Prediction and Prevention of Pressure Ulcers.
一项针对压力性溃疡预测与预防的临床实践指南（卫生保健政策与研究机构[AHCPR]，1992年）在加拿大一所大学附属医院的急性护理医院中进行了评估。通过一项前瞻性研究，确定了压力性溃疡的患病率，并跟踪压力性溃疡发病率以评估布拉德恩量表进行风险评估的准确性。II期及以上压力性溃疡的患病率为13.6%；若将I期（持续性发红）纳入计算，该患病率为29.7%。在评估布拉德恩量表预测风险的准确性时，本研究的结果不如之前的报告那样乐观。敏感性（67%）和特异性（66%）之间似乎具有最佳平衡的布拉德恩总分是19分。应考虑几个因素：该量表在全院范围内针对广泛的患者诊断、年龄和严重程度进行了实施和测试；该研究是对现有患者群体的横断面研究；各科室之间的护理水平和工作人员类型有所不同，涵盖了从重症监护到长期护理等不同类型的科室。本研究强调了各医疗机构需要对AHCPR压力性溃疡预测与预防指南进行评估。
