改良版Cubbin&Jackson量表诊断ICU患者压力性损伤最佳界值的多中心研究

A multicenter study on the applicability and optimal cut-off of the revised Cubbin&Jackson scale in the diagnosis of pressure injury in ICU patients

目的探讨改良版Cubbin&Jackson量表诊断国内ICU患者压力性损伤的适用性和最佳界值。方法采用便利抽样法,选取2021年4月—2022年10月在甘肃省35所三级医院住院的6203例ICU患者作为调查对象,由经过规范化培训的ICU护士检查患者全身皮肤并收集相关资料,判定是否存在压力性损伤及其分期,同时采用改良版Cubbin&Jackson量表进行压力性损伤风险评估。使用软件统计分析改良版Cubbin&Jackson量表诊断ICU患者压力性损伤的受试者工作特征曲线下面积(area under the curve,AUC)、约登指数、灵敏度和特异度等指标。结果6203例ICU患者住院期间共有79例发生压力性损伤,发生率为1.27%。分层分析显示,改良版Cubbin&Jackson量表预测诊断不同性别、年龄、ICU住院天数、是否机械通气和是否手术的ICU患者压力性损伤的AUC为0.74~0.92,约登指数为0.40~0.74,灵敏度和特异度分别为77.27%~94.44%、62.44%~82.63%。总分≤28分时,改良版Cubbin&Jackson量表的AUC最大(0.86),其约登指数、灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为0.60、92.41%、67.26%、3.50%、99.86%、2.82、0.11。结论改良版Cubbin&Jackson量表可作为有效预测、诊断国内ICU患者压力性损伤的适用工具,最佳界值以≤28分为宜。

Objective To explore the applicability and optimal cut-off of the revised Cubbin&Jackson scale in the diagnosis of pressure injury in ICU patients in China.Methods From April 2021 to October 2022,6203 ICU patients from 35 tertiary hospitals in Gansu Province were included in the study by convenience sampling method.The standardized trained ICU nurses examined the skin and collected relevant data,determined whether or not there was pressure injury and its stage,and simultaneously used the revised Cubbin&Jackson scale for pressure injury risk assessment.The software was used to statistically analyze the area under the receive operating characteristic curve(AUC),Yoden index,sensitivity,specificity and other indexes of the revised Cubbin&Jackson scale in the diagnosis of pressure injury in ICU patients.Results A total of 79 cases of pressure injury occurred during hospitalization in 6203 ICU patients,with an incidence of 1.27%.Hierarchical analysis showed that the AUC of the revised Cubbin&Jackson scale in the prediction and diagnosis of pressure injury ranged from 0.74 to 0.92 in ICU patients with different sex,age,length of ICU stay,whether or not mechanically ventilated,and whether or not surgical.The Yoden index,sensitivity and specificity were 0.40—0.74,77.27%—94.44%and 62.44%—82.63%,respectively.When the total score was≤28 points,the revised Cubbin&Jackson scale obtained the highest AUC(0.86),and the Yoden index,sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,and negative likelihood ratio were 0.60,92.41%,67.26%,3.50%,99.86%,2.82 and 0.11,respectively.Conclusion The revised Cubbin&Jackson scale can be used as a suitable tool to effectively predict and diagnose pressure injury in ICU patients in China,and the optimal cut-off of≤28 points is appropriate.