成人骨科术中压力性损伤危险因素评估表的设计

Design of the risk factors evaluation form for pressure injury in adult orthopedic operations

目的编制成人骨科术中压力性损伤危险因素评估表,检测评估表的灵敏度和特异度。方法基于文献回顾和现有压力性损伤危险因素评估表的条目,提取成人骨科术中压力性危险因素,经专家会议、德尔菲专家咨询,形成成人骨科术中压力性损伤危险因素评估表。便利选取2017年1—6月在某三级甲等医院行择期手术的1701例成人骨科手术患者,分别于术前、术中和术后3个阶段进行评估。在患者离开手术室时及返回病房后24、48、72 h时评估皮肤状况。根据评分计算术前、术中和术后3个阶段的ROC曲线下面积,确定各阶段评分的最佳诊断界值及对应的灵敏度、特异度。结果评估表包括术前、术中、术后3个阶段,共27个条目,每个阶段的评分累加。内容效度指数(CVI)为0.867,术前、术中、术后评估的评估者间一致性信度系数分别为0.977、0.927、0.900,ROC曲线下面积分别为0.878、0.911、0.918,最佳诊断界值分别为14、38、41分,对应的灵敏度分别为0.829、0.805、0.865,特异度分别为0.832、0.925、0.885。结论该评估表评估者间的一致性、灵敏度和特异度高,可实现分阶段动态评估,能够作为手术室医护人员评估成人骨科手术患者术中压力性损伤风险的有效工具。

Objective To design risk factors evaluation form for pressure injury in adult orthopedic operations and to test its sensitivity and specificity.Methods Based on the literature review and the items in the existing risk factor assessment form of stress injury,the risk factors of stress injury in adult orthopedics were extracted.After an expert meeting and Delphi expert consultation,an evaluation form of risk factors for stress injury in adult orthopedics was formed.A total of 1701 adult orthopedic patients who underwent elective surgery in a ClassⅢGrade A hospital from January to June 2017 were selected and they were evaluated at preoperative,intraoperative and postoperative stages.The area under the ROC curve of preoperative,intraoperative and postoperative three stages was calculated according to the scores,and the optimal diagnostic threshold and corresponding sensitivity and specificity were determined for the scores of each stage.Results The evaluation form included preoperative,intraoperative and postoperative stages and 27 items.The scores of each stage were accumulated.The content validity index(CVI)was 0.867,and inter-assessment consistency coefficients of pre-assessment,intra-operative and post-assessment assessments were 0.977,0.927 and 0.900.The area under the ROC curve was 0.878,0.911 and 0.918,and the best diagnostic cutoff values were respectively 14,38,and 41.The corresponding sensitivities were 0.829,0.805 and 0.865,and the specificities were respectively 0.832,0.925 and 0.885.Conclusions The assessment form has high consistency,sensitivity and specificity among assessors,which can realize dynamic assessment in stages and can be used as an effective tool for medical staff in the operating room to assess the risk of intraoperative pressure injury in adult patients undergoing orthopedic surgery.