肠造口周围潮湿相关性皮肤损伤风险评估量表的构建与信效度检验

Construction of a Risk Assessment Scale for Peristomal Moisture-Associated Skin Damage and testing its reliability and validity

目的构建肠造口周围潮湿相关性皮肤损伤风险评估量表,为临床评价肠造口周围潮湿相关性皮肤损伤风险提供评估工具。方法在文献分析基础上整理肠造口周围潮湿相关性皮肤损伤相关风险因素并形成初始条目池。通过专家会议法、2轮德尔菲专家函询,对指标体系进行修订,形成肠造口周围潮湿相关性皮肤损伤风险评估量表。调查普外科行肠造口手术患者118例,对评估量表进行信效度检验。结果构建的正式量表包括4个一级指标,11个二级指标,21个三级指标。量表水平的平均内容效度指数(S-CVI/ave)为0.956,条目水平的内容效度指数(I-CVI)为0.914-1.000。118例肠造口手术患者中发生肠造口周围潮湿相关性皮肤损伤42例(35.59%)。量表预测效度ROC曲线下面积(AUC)为0.865(P<0.001),当量表临界值为14.5时,Youden指数为0.525,灵敏度为0.643,特异度为0.882。量表总的Krippendorff′sα系数为0.794,一级指标的Krippendorff′sα系数0.651-0.779。结论构建的肠造口周围潮湿相关性皮肤损伤风险评估量表具有良好的信度和效度,为临床护理人员早期识别高危患者提供了有效的评估工具,以减少肠造口患者皮肤损伤。

Objective To develop a risk assessment scale for peristomal moisture-associated skin damage,in order to provide a clinical tool for assessing the risk of such damage.Methods On the basis of literature analysis,the related risk factors of peristomal moisture-associated skin damage were compiled to form an initial item pool.Through expert meeting method and two rounds of Delphi expert letter consultation,the index system was revised to form the risk assessment scale of peristomal moisture-associated skin damage.The reliability and validity of the evaluation scale were tested in 118 patients who underwent enterostomy operations in the department of general surgery.Results The formal scale consisted of 4 first-level indicators,11 second-level indicators and 21 third-level indicators.The average content validity index(S-CVI/ave)at scale level was 0.956,and the content validity index(I-CVI)at item level was 0.914-1.000.Among 118 patients undergoing enterostomy,42(35.59%)had peristomal moisture-associated skin damage.The predictive validity area under ROC curve(AUC)of the scale was 0.865(P<0.001).When the critical value of the scale was 14.5,the Youden index was 0.525,the sensitivity was 0.643,and the specificity was 0.882.The total Krippendorff′sαcoefficient of the scale was 0.794,and the Krippendorff′sαcoefficient of the first-level indicators were 0.651-0.779.Conclusion The constructed risk assessment scale for peristomal moisture-associated skin damage demonstrates good reliability and validity,which provides an effective assessment tool for clinical nursing staff to identify high-risk patients early and reduce skin damage in patients with enterostomy.