Braden量表评分联合急性生理学与慢性健康状况评分系统Ⅱ评分预测压疮发生的价值

Prediction of Pressure Ulcer by Combination of Braden Scale Score and Acute Physiology and Chronic Health Evaluation Ⅱ Score

背景压疮评估在压疮护理工作中是至关重要的一步。目前广泛应用的压疮评估工具是Braden量表,但是其评估临床压疮风险存在一定的局限性。目的评估Braden量表评分联合急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分预测压疮发生的价值。方法选取2014年6月—2015年6月重庆市中医院ICU、CCU、心血管病科、肝病科、肿瘤科、肾病科、骨科、急诊科等临床科室上报的310例患者为研究对象。收集患者Braden量表评分及APACHEⅡ评分。Braden量表评分≤12分预测为压疮高风险,Braden量表评分>12分预测为压疮低风险;以Braden量表评分≤12分,且APACHEⅡ评分≥15分预测为压疮高风险,否则预测为压疮低风险。制作Braden量表评分、Braden量表评分联合APACHEⅡ评分预测压疮发生的受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC)、灵敏度、特异度、阳性预测值、阴性预测值。结果 310例患者住院期间发生压疮57例,未发生压疮253例。Braden量表评分预测压疮高风险310例,压疮低风险0例。Braden量表评分预测压疮发生的AUC为0.326,95%CI(0.241,0.410);以12分为临界值时,预测压疮发生的灵敏度为100.0%,特异度为0,阳性预测值为18.4%,阴性预测值为0,Youden's指数为0。Braden量表评分联合APACHEⅡ评分预测压疮高风险63例(其中发生压疮54例),压疮低风险247例(其中发生压疮3例)。Braden量表评分联合APACHEⅡ评分预测压疮发生的AUC为0.946,95%CI(0.897,0.994);以Braden量表评分12分、APACHEⅡ评分15分为临界值时,预测压疮发生的灵敏度为94.7%,特异度为96.4%,阳性预测值为85.7%,阴性预测值为98.8%,Youden's指数为0.911。Braden量表评分联合APACHEⅡ评分预测压疮发生的Kappa值为0.876(P=0.035)。Braden量表评分联合APACHEⅡ评分预测压疮发生的AUC大于Braden量表评分预测压疮发生的AUC(Z=6.92,P<0.05)。结论 Braden量表评分联合APACHEⅡ评分能较好地预测压疮的发生情况。

Background Pressure ulcer assessment is a crucial step in the nursing of pressure ulcer. Braden Scale is a widely used evaluation tool in current assessment of pressure ulcer,but there are limitations in the risk prediction of pressure ulcer in clinic. Objective To evaluate the value of Braden Scale score combined with acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score in pressure ulcer prediction. Methods 310 patients reported by clinic departments（including ICU,CCU,Department of Cardiovascular Disease, Liver Disease, Oncology, Nephrology, Orthopaedics, Emergency, etc. ） from Traditional Chinese Medicine Hospital in Chongqing from June 2014 to June 2015 were selected as the research objects. Patients＆#39;scores of Braden Scale and APACHE Ⅱ were collected. The patients scored not more than 12 in Braden Scale were predicted as high - risk pressure ulcer,while those who scored greater than 12 were low - risk pressure ulcer;the patients scored not more than 12 in Braden Scale and not less than 15 in APACHE Ⅱ were predicted as high - risk pressure ulcer,otherwise they would be taken as low - risk pressure ulcer. The receiver operating characteristic（ROC）curve was predicted by Braden Scale or Braden Scale score combined with APACHE Ⅱ score. The areas under curve （ AUC） of ROC,sensibility,specificity,positive predictive value and negative predictive value were also calculated. Results 57 patients developed pressure ulcer,and 253 patients didn＆#39;t among the 310 inpatients. The 310 patients were predicted as high - risk pressure ulcer and 0 patients were low -risk pressure ulcer by Braden Scale score. The AUC of the occurrence of pressure ulcer predicted by Braden Scale score was 0. 326,95% CI（ 0. 241,0. 410 ）;with 12 as the critical value,the sensitivity,specificity,positive predictive value, negative predictive value,and Youden＆#39;s index of predicting the occurrence of pressure ulcer were 100% ,0,18. 4% ,0, 18. 4% ,0,and 0 respectively. 63 high - risk patients（54 cases occurred pressure ulcer）and 247 low - risk patients（3 cases occurred pressure ulcer）were predicted by Braden Scale score combined with APACHE Ⅱ score. The AUC of pressure ulcer predicted by Braden Scale score combined with APACHE Ⅱ score was 0. 946,95% CI（0. 897,0. 994）;when the critical value of Braden Scale score and APACHE Ⅱ score was 12 and 15 separately,the sensitivity,specificity,positive predictive value,negative predictive value,and Youden＆#39;s index of predicting pressure ulcer occurrence were 94. 7% ,96. 4% ,85. 7% , 98. 8% ,and 0. 911 respectively. The Kappa value of pressure ulcer occurrence predicted by Braden Scale score combined with APACHE Ⅱ score was 0. 876（ P = 0. 035）. The AUC of pressure ulcer predicted by Braden Scale score combined with APACHE Ⅱ score was greater than that predicted by Braden Scale score（Z = 6. 92,P ﹤ 0. 05）. Conclusion Braden Scale score combined with APACHE Ⅱ score can better predict the occurrence of pressure ulcer.