基于德尔菲法构建烧伤患者面颈部创面与瘢痕地形图评估系统

Establishment of a topographic map assessment system for facial and cervical wounds and scars of burn patients based on the Delphi method

目的构建一套适用于烧伤患者面颈部创面和瘢痕的针对性精准评估系统。方法采用文献分析和调查研究相结合的方法,遵循条目体系构建的基本原则。2020年6—8月,以面颈部整形美学标准为基础,患者烧伤后面颈部创面与瘢痕评估为中心,初步形成烧伤患者面颈部创面与瘢痕地形图评估系统。于2020年9月对38名相关领域专家行预函询,并根据专家意见修改问卷。2020年12月—2021年3月,运用德尔菲法对符合入选标准的35名来自广州、深圳、上海、北京等地相关领域专家开展函询,筛选并确立条目。计算函询问卷有效回收率,判断专家积极程度;计算所有条目的权威系数均值,判断专家权威程度;计算所有三级条目的重要性专家评分均值、变异系数均值和满分率均值,判断专家意见集中程度;计算所有三级条目的重要性、敏感性和可操作性专家评分变异系数均值、肯德尔和谐系数,判断专家意见协调程度。对函询中所有三级条目的重要性、敏感性和可操作性专家评分的肯德尔和谐系数行χ^(2)检验。结果经德尔菲法函询的35名专家以男性居多,年龄为(48±10)岁,工作年限8~38年,副高及以上职称者为主,均为本科及以上学历,烧伤科专家11人、创面修复科专家7人、整形美容科专家4人、康复医学科专家13人。最后形成包含4个一级条目、21个二级条目、40个三级条目和1个面谱的烧伤患者面颈部创面与瘢痕地形图评估系统。函询问卷有效回收率为100%(35/35)。所有条目的权威系数均值为0.89。所有三级条目的重要性专家评分均值为4.67分,重要性专家评分变异系数均值为0.01,满分率均值为86.3%。所有三级条目的重要性、敏感性、可操作性专家评分的变异系数均值分别为0.01、0.01、0.02。所有三级条目的重要性、敏感性、可操作性专家评分的肯德尔和谐系数检验,结果均有统计学意义(χ^(2)值分别为1201.53、745.67、707.07,P<0.05)。结论构建的烧伤患者面颈部创面与瘢痕地形图评估系统具有较高的科学性、可靠性,可用于烧伤患者面颈部创面或瘢痕的评估。

Objective To construct a targeted and accurate evaluation system for facial and cervical wounds and scars of burn patients.Methods The method combining literature analysis and survey research was adopted,and the basic principles of item system construction were followed.From June to August 2020,based on the aesthetic standards of facial and cervical plastic surgery,the topographic map assessment system for facial and cervical wounds and scars of burn patients was preliminarily formed,focusing on the assessment of wounds and scars in the necks and faces of patients after burns.In September 2020,38 experts in the relevant fields were consulted in advance and the questionnaire was revised according to the experts'opinions.From December 2020 to March 2021,the Delphi method was applied to conduct inquiry by correspondence with 35 experts in relevant fields from Guangzhou,Shenzhen,Shanghai,Beijing,and other cities,who met the inclusion criteria,and the items were screened and established.The effective recovery rate of inquiry questionnaire was calculated to determine the level of enthusiasm of experts,the average authority coefficient of all items was calculated to determine the level of expert authority,the average importance expert score,the average coefficient of variation,and the average full score rate of all the third-level items were calculated to determine the concentration of expert opinions,the average coefficients of variation and Kendall's harmony coefficients of the importance,sensitivity,and operability expert scores of all the third-level items were calculated to determine the degree of coordination of expert opinions.The Kendall's harmony coefficients for the importance,sensitivity,and operability expert scores of all the third-level items were statistically analyzed with chi-square test.Results Among the 35 experts consulted by Delphi method,mainly were male,aged(48±10)years,with 8-38 years of working experience,mainly with associate senior titles and above,all with a bachelor's degree or above education background,and of whom 11 were burn experts,7 were wound repair experts,4 were plastic surgery experts,and 13 were rehabilitation medicine experts.Finally,a topographic map assessment system for facial and cervical wounds and scars of burn patients was formed,including 4 first-level items,21 second-level items,40 third-level items,and 1 mask.The effective recovery rate of inquiry questionnaire was 100%(35/35).The average authority coefficient of all items was 0.89.The average importance expert score was 4.67,the average coefficient of variation of importance expert score was 0.01,and the average full score rate of all the third-level items was 86.3%.The average coefficients of variation of the importance,sensitivity,and operability expert scores of all the third-level items were 0.01,0.01,and 0.02,respectively.The Kendall's harmony coefficients for the importance,sensitivity,and operability expert scores of all the third-level items were statistically significant(with χ^(2) values of 1201.53,745.67,and 707.07,respectively,P<0.05).Conclusions The established topographic map assessment system for facial and cervical wounds and scars of burn patients has high scientificity and reliability,which can be used for the evaluation of facial and neck wounds or scars in burn patients.