Aims:Paediatric pressure ulcers are a serious problem to healthcare service.Thus,effective and early identification of the risk of developing pressure ulcer is essential.The Braden Q scale is a widely used tool in the...Aims:Paediatric pressure ulcers are a serious problem to healthcare service.Thus,effective and early identification of the risk of developing pressure ulcer is essential.The Braden Q scale is a widely used tool in the risk assessment of paediatric pressure ulcer,but its predictive power is controversial.Hence,we performed a meta-analysis to evaluate the predictive power of the Braden Q scale for pressure ulcer in hospitalised children and offer recommendations for clinical decision.Methods:Studies that evaluated the predictive power of the Braden Q scale were searched through databases in English and Chinese,including Medline,Cochrane Library,Embase,CINAHL,SinoMed,CNKI,Wangfang and VIP.The studies were screened by two independent reviewers.QUADAS-2 was used to assess the risk of bias of eligible studies.Demographic data and predictive value indices were extracted.The pooled sensitivity,specificity and receiver operating characteristics(ROC)were calculated by MetaDiSc 1.4 using random-effects models.Results:Cochran Q=26.13(P=0.0036)indicated the existence of heterogeneity;the I2 for pooled DOR was 61.7%,suggesting significant heterogeneity among the included studies.The pooled sensitivity and specificity were 0.73(95%CI:0.67-0.78)and 0.61(95%CI:0.59-0.63),respectively,yielding a combined DOR of 3.47(95%CI:2-6.01).The area under the ROC curve was 0.7078±0.0421,and the overall diagnostic accuracy(Q*)was 0.6591±0.0337.Sensitivity analysis showed the results were robust.Conclusion:The Braden Q scale has moderate predictive validity with medium sensitivity and low specificity for pressure ulcers in hospitalised children.Further development and modification of this tool for use in paediatric population are warranted.展开更多
BACKGROUND More than ten special scales are available to predict the risk of pressure ulcers in children.However,the performances of those scales have not yet been compared in China.AIM To compare the Waterlow,Braden ...BACKGROUND More than ten special scales are available to predict the risk of pressure ulcers in children.However,the performances of those scales have not yet been compared in China.AIM To compare the Waterlow,Braden Q,and Glamorgan scales,and identify more suitable pressure ulcer evaluation scale for the pediatric intensive care unit(PICU).METHODS Trained nurses used the Waterlow,Braden Q,and Glamorgan scales to assess pediatric patients at Sun Yat-sen Memorial Hospital(China)within 24 h of admission from May 2017 to December 2020 in two stages.Skin examination was carried out to identify pressure ulcers every 3 d for 3 wk.RESULTS The incidence of pressure ulcers was 3/28(10.7%)in the PICU and 5/314(1.6%)in the general pediatric ward.For children in the general ward,the Waterlow,Braden Q,and Glamorgan scales had comparable area under the operating characteristic curve(AUC)of 0.870,0.924,and 0.923,respectively,and optimal cut-off values of 14,14,and 29 points.For PICU,the Waterlow,Braden Q,and Glamorgan scales had slightly lower AUC of 0.833,0.733,and 0.800,respectively,and optimal cut-off values of 13,16,and 27 points.Braden Q demonstrated a satisfactory specificity,and during the second stage of the study for PICU patients,the AUC of the Braden Q scale was 0.810,with an optimal cut-off value of 18.35 points.CONCLUSION The Waterlow,Braden Q,and Glamorgan scales have comparable performance while the Braden Q scale demonstrates a better specificity and can be successfully used by pediatric nurses to identify patients at high risk of pressure ulcers in PICU.展开更多
Objective: The purpose of this study was to: ( 1 ) observe the value of the score of Braden Q scale in predicting pressure ulcers in pediatric Intensive Care Unit ( ICU) patients in China, ( 2) determine the critical ...Objective: The purpose of this study was to: ( 1 ) observe the value of the score of Braden Q scale in predicting pressure ulcers in pediatric Intensive Care Unit ( ICU) patients in China, ( 2) determine the critical cutoff point for classifying patient risk, and ( 3) describe the pressure ulcer incidence. Methods: A prospective cohort descriptive study with a convenience sample of 198 patients bed-ridden for at least 24 hours without pre-existing pressure ulcers enrolled from a pediatric intensive care unit ( PICU) . The Braden Q score and skin assessment were independently rated, and data collectors were blinded to the other measures. Patients were observed for up to 3 times per week for 2 weeks and once a week thereafter until PICU discharge. Results: Fourteen patients ( 7. 1%) developed pressure ulcers; 12 ( 85. 7%) were Stage I pres-sure ulcers, 2 ( 14. 3%) were Stage II, and there were no Stage III or IV pressure ulcers. Most pressure ulcers ( 64. 3%) were present at the first observation. The Braden Q Scale has an overall cumulative variance contribution rate of 69. 599%. Using Stage I+ pressure ulcer data obtained during the first observation, a Receiver Operator Characteristic ( ROC) curve for each possible score of the Braden Q Scale was constructed. The area under the curve ( AUC) was 0. 57, and the 95% confidence interval was 0. 50-0. 62. At a cutoff score of 19, the sensitivity was 0. 71, and the specificity was 0. 53. The AUC of each item of the Braden Q Scale was 0. 543-0. 612. Conclusions: PICU patients are susceptible to pressure ulcers. The value of the Braden Q Scale in the studied pediatric population was relatively poor, and it should be optimized before it is used in Chinese pediatric patients.展开更多
Objective:To translate an intensive care-specific pressure injury risk assessment tool(the COMHON Index)from English into Chinese Mandarin.Methods:A four-step approach to instrument translation was utilised:1)English-...Objective:To translate an intensive care-specific pressure injury risk assessment tool(the COMHON Index)from English into Chinese Mandarin.Methods:A four-step approach to instrument translation was utilised:1)English-Mandarin forward-translation by three independent bilinguists;2)Mandarin-English back-translation by two other inde-pendent bilinguists;3)comparison of forward and back-translations,identification of discrepancies,with required amendments returned to step one;and 4)piloting of the translated instrument.The pilot study was undertaken in a Chinese surgical intensive care unit with a convenience sample of 20 nurses.A five-point ordinal scale(1=very difficult;5=very easy)was used to assess ease-of-use and understanding.Translations were retained where medians4 indicated use and understanding was easy to very easy.Results:Five iterations of steps 1 to 3,and two sets of amendments to the original English instrument,were required to achieve translation consensus prior to pilot testing.Subscale scoring,sum scoring,and risk categorisation were documented in most pilot assessments(≥80%),but three sum scores were incorrectly tallied.The overall tool and all subscales were easy to use and understand(medians≥4),and most assessments(16/20,80%)took5 min to complete.Thus,translations were retained,with minor amendments made to instrument instructions for scoring and risk categorisation.Conclusions:An easy-to-use Chinese Mandarin intensive care-specific pressure injury risk assessment tool has been introduced through cross-cultural translation.However,it requires further testing of interrater reliability and agreement.A rigorous translation and reporting exemplar is presented that provides guidance for future translations.展开更多
目的：评价和确定Braden-Q儿童压疮评估量表用于诊断住院患儿压疮高风险的最佳临界值。方法：对2014年1至6月在我院住院且Braden-Q量表≤24分的372例患者进行住院期间压疮发生情况追踪分析,采用灵敏度、特异度、阳性预测值、阴性预测值...目的：评价和确定Braden-Q儿童压疮评估量表用于诊断住院患儿压疮高风险的最佳临界值。方法：对2014年1至6月在我院住院且Braden-Q量表≤24分的372例患者进行住院期间压疮发生情况追踪分析,采用灵敏度、特异度、阳性预测值、阴性预测值、约登指数和受试者工作特征曲线（receiver operating characteristic,ROC）确定和评价Braden-Q量表诊断压疮高度危险的临界值。结果：372例研究对象中有37.73%的患者Braden-Q评分≤16分（最低11分）,72.27%的患者Braden-Q评分17～24分;共发生院内压疮21例,其分值主要集中在13～16分。当Braden-Q量表诊断压疮高危的临界值为16分时,其预测压疮危险的灵敏度为0.826,特异度为0.759,阳性预测值为0.185,阴性预测值为0.985,约登指数（0.585）较其他临界值更大,Braden-Q量表ROC曲线下面积（area under curve,AUC）为0.923。结论：Braden-Q量表16分是诊断儿童压疮高度危险的最佳临界值,能够很好地预测儿童发生压疮的风险,具有较高的诊断价值。展开更多
文摘Aims:Paediatric pressure ulcers are a serious problem to healthcare service.Thus,effective and early identification of the risk of developing pressure ulcer is essential.The Braden Q scale is a widely used tool in the risk assessment of paediatric pressure ulcer,but its predictive power is controversial.Hence,we performed a meta-analysis to evaluate the predictive power of the Braden Q scale for pressure ulcer in hospitalised children and offer recommendations for clinical decision.Methods:Studies that evaluated the predictive power of the Braden Q scale were searched through databases in English and Chinese,including Medline,Cochrane Library,Embase,CINAHL,SinoMed,CNKI,Wangfang and VIP.The studies were screened by two independent reviewers.QUADAS-2 was used to assess the risk of bias of eligible studies.Demographic data and predictive value indices were extracted.The pooled sensitivity,specificity and receiver operating characteristics(ROC)were calculated by MetaDiSc 1.4 using random-effects models.Results:Cochran Q=26.13(P=0.0036)indicated the existence of heterogeneity;the I2 for pooled DOR was 61.7%,suggesting significant heterogeneity among the included studies.The pooled sensitivity and specificity were 0.73(95%CI:0.67-0.78)and 0.61(95%CI:0.59-0.63),respectively,yielding a combined DOR of 3.47(95%CI:2-6.01).The area under the ROC curve was 0.7078±0.0421,and the overall diagnostic accuracy(Q*)was 0.6591±0.0337.Sensitivity analysis showed the results were robust.Conclusion:The Braden Q scale has moderate predictive validity with medium sensitivity and low specificity for pressure ulcers in hospitalised children.Further development and modification of this tool for use in paediatric population are warranted.
基金the ethics committee of Sun Yat-sen Memorial hospital[approval number:2017(23)]。
文摘BACKGROUND More than ten special scales are available to predict the risk of pressure ulcers in children.However,the performances of those scales have not yet been compared in China.AIM To compare the Waterlow,Braden Q,and Glamorgan scales,and identify more suitable pressure ulcer evaluation scale for the pediatric intensive care unit(PICU).METHODS Trained nurses used the Waterlow,Braden Q,and Glamorgan scales to assess pediatric patients at Sun Yat-sen Memorial Hospital(China)within 24 h of admission from May 2017 to December 2020 in two stages.Skin examination was carried out to identify pressure ulcers every 3 d for 3 wk.RESULTS The incidence of pressure ulcers was 3/28(10.7%)in the PICU and 5/314(1.6%)in the general pediatric ward.For children in the general ward,the Waterlow,Braden Q,and Glamorgan scales had comparable area under the operating characteristic curve(AUC)of 0.870,0.924,and 0.923,respectively,and optimal cut-off values of 14,14,and 29 points.For PICU,the Waterlow,Braden Q,and Glamorgan scales had slightly lower AUC of 0.833,0.733,and 0.800,respectively,and optimal cut-off values of 13,16,and 27 points.Braden Q demonstrated a satisfactory specificity,and during the second stage of the study for PICU patients,the AUC of the Braden Q scale was 0.810,with an optimal cut-off value of 18.35 points.CONCLUSION The Waterlow,Braden Q,and Glamorgan scales have comparable performance while the Braden Q scale demonstrates a better specificity and can be successfully used by pediatric nurses to identify patients at high risk of pressure ulcers in PICU.
文摘Objective: The purpose of this study was to: ( 1 ) observe the value of the score of Braden Q scale in predicting pressure ulcers in pediatric Intensive Care Unit ( ICU) patients in China, ( 2) determine the critical cutoff point for classifying patient risk, and ( 3) describe the pressure ulcer incidence. Methods: A prospective cohort descriptive study with a convenience sample of 198 patients bed-ridden for at least 24 hours without pre-existing pressure ulcers enrolled from a pediatric intensive care unit ( PICU) . The Braden Q score and skin assessment were independently rated, and data collectors were blinded to the other measures. Patients were observed for up to 3 times per week for 2 weeks and once a week thereafter until PICU discharge. Results: Fourteen patients ( 7. 1%) developed pressure ulcers; 12 ( 85. 7%) were Stage I pres-sure ulcers, 2 ( 14. 3%) were Stage II, and there were no Stage III or IV pressure ulcers. Most pressure ulcers ( 64. 3%) were present at the first observation. The Braden Q Scale has an overall cumulative variance contribution rate of 69. 599%. Using Stage I+ pressure ulcer data obtained during the first observation, a Receiver Operator Characteristic ( ROC) curve for each possible score of the Braden Q Scale was constructed. The area under the curve ( AUC) was 0. 57, and the 95% confidence interval was 0. 50-0. 62. At a cutoff score of 19, the sensitivity was 0. 71, and the specificity was 0. 53. The AUC of each item of the Braden Q Scale was 0. 543-0. 612. Conclusions: PICU patients are susceptible to pressure ulcers. The value of the Braden Q Scale in the studied pediatric population was relatively poor, and it should be optimized before it is used in Chinese pediatric patients.
基金supported in part by a PhD scholarship awarded to the first author by The Prince Charles Hospital Foundation[grant number PhD2019-01]。
文摘Objective:To translate an intensive care-specific pressure injury risk assessment tool(the COMHON Index)from English into Chinese Mandarin.Methods:A four-step approach to instrument translation was utilised:1)English-Mandarin forward-translation by three independent bilinguists;2)Mandarin-English back-translation by two other inde-pendent bilinguists;3)comparison of forward and back-translations,identification of discrepancies,with required amendments returned to step one;and 4)piloting of the translated instrument.The pilot study was undertaken in a Chinese surgical intensive care unit with a convenience sample of 20 nurses.A five-point ordinal scale(1=very difficult;5=very easy)was used to assess ease-of-use and understanding.Translations were retained where medians4 indicated use and understanding was easy to very easy.Results:Five iterations of steps 1 to 3,and two sets of amendments to the original English instrument,were required to achieve translation consensus prior to pilot testing.Subscale scoring,sum scoring,and risk categorisation were documented in most pilot assessments(≥80%),but three sum scores were incorrectly tallied.The overall tool and all subscales were easy to use and understand(medians≥4),and most assessments(16/20,80%)took5 min to complete.Thus,translations were retained,with minor amendments made to instrument instructions for scoring and risk categorisation.Conclusions:An easy-to-use Chinese Mandarin intensive care-specific pressure injury risk assessment tool has been introduced through cross-cultural translation.However,it requires further testing of interrater reliability and agreement.A rigorous translation and reporting exemplar is presented that provides guidance for future translations.
文摘目的：评价和确定Braden-Q儿童压疮评估量表用于诊断住院患儿压疮高风险的最佳临界值。方法：对2014年1至6月在我院住院且Braden-Q量表≤24分的372例患者进行住院期间压疮发生情况追踪分析,采用灵敏度、特异度、阳性预测值、阴性预测值、约登指数和受试者工作特征曲线（receiver operating characteristic,ROC）确定和评价Braden-Q量表诊断压疮高度危险的临界值。结果：372例研究对象中有37.73%的患者Braden-Q评分≤16分（最低11分）,72.27%的患者Braden-Q评分17～24分;共发生院内压疮21例,其分值主要集中在13～16分。当Braden-Q量表诊断压疮高危的临界值为16分时,其预测压疮危险的灵敏度为0.826,特异度为0.759,阳性预测值为0.185,阴性预测值为0.985,约登指数（0.585）较其他临界值更大,Braden-Q量表ROC曲线下面积（area under curve,AUC）为0.923。结论：Braden-Q量表16分是诊断儿童压疮高度危险的最佳临界值,能够很好地预测儿童发生压疮的风险,具有较高的诊断价值。
