Predictive accuracy of the Braden Q Scale in risk assessment for paediatric pressure ulcer: A meta-analysis

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.

Predictive risk scales for development of pressure ulcers in pediatric patients admitted to general ward and intensive care unit

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.

Predicting Pressure Ulcer Risk with the Braden Q Scale in Chinese Pediatric Patients in ICU

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.

Prevalence and Risk Factors of Postoperative Pressure Ulcers:A Systematic Review and Meta-analysis of Diagnostic Test

[Objectives]The paper was to analyze the total prevalence of postoperative pressure ulcers in patients and to reveal the epidemic law.[Methods]By searching English databases such as PubMed,Google Academics,Scopus,Science Direct and Web of Science(WOS),a total of 2018 English articles on pressure ulcers published from January 2015 to December 2020 were selected.According to the inclusion criteria,19 high-quality literatures were selected for the study,and the extended function of meta-analysis software of Review Manager 5.1 diagnostic test was used for data statistics and meta analysis of the results.[Results]There were 19 literatures with a total of 9400 patients included in the meta-analysis.The results showed that the total prevalence estimate of postoperative pressure ulcers was 20.00%(CI 95%:15.3-24.1).The total prevalence estimate of postoperative pressure ulcers in males was 10.1%(CI 95%:7.2-13.02),and that in females was 12.8%(CI 95%:8.1-17.3).The total prevalence estimates of stage I to IV postoperative pressure ulcers were 17.02%(CI 95%:11.06-22.09),6.7%(CI 95%:3.76-9.69),0.9%(CI 95%:0.21-1.26)and 0.4%(CI 95%:-0.05-0.8),respectively.[Conclusions]The prevalence of postoperative pressure ulcers is generally high.The prevalence of postoperative pressure ulcers in females is higher than that in males,and the prevalence of stage I pressure ulcers is higher than that of other stages,which is related to age,gender and other related risk factors.

Pressure Ulcers in Institutionalized Elderly People:Association of Sociodemographic and Clinical Characteristics and Risk Factors

Objective: To evaluate the association of socio-demographic and clinical characteristics, and risk factors with occurrence of pressure ulcers in institutionalized elderly people. Method: This cross-sectional, analytical study, in quantitative approach, performed from the database analysis linked to the project “Pressure Ulcer in institutionalized elderly people: Association of incidence with the risk factors to functional and nutritional assessment” developed in six long-stay institutions for the elderly people in Jo&atildeo Pessoa. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0. Associations were made through chi square test and Odds Ratio. Results: The clinical conditions of significant associations with the occurrence of pressure ulcers were the variables neurological disorders (p = 0.011) and visual impairment (p = 0.005). As for risk factors, the most important was fecal incontinence (p Conclusion: The analysis of the associations pointed out problems that require intervention in order to prevent health implications of the elderly people and to minimize the risk and occurrence of this injury.

俯卧位通气相关面部压力性损伤危险因素分析及最佳建模方法选择

背景面部压力性损伤是俯卧位通气患者常见并发症,创面局部暴露可增加全身感染风险,影响俯卧位通气治疗效果,甚至造成局部组织永久性功能损害。探讨其危险因素并构建预测模型对于预防俯卧位通气相关面部压力性损伤具有重要临床意义。目的探讨俯卧位通气相关面部压力性损伤的危险因素及其最佳建模方法。方法选择2020年6月—2023年3月入住新疆医科大学第一附属医院重症医学科的159例接受俯卧位通气的患者为研究对象,根据是否发生面部压力性损伤分为压力性损伤组(n=22)和非压力性损伤组(n=137),收集患者的一般信息、疾病诊断、治疗措施、实验室检查。分别使用逐步Logistic回归模型、全变量Logistic回归模型及Lasso-Logistic回归模型筛选面部压力性损伤危险因素并建立预测模型,应用受试者工作特征曲线下面积(AUC)评价模型区分度;应用赤池信息准则(AIC)、贝叶斯信息准则(BIC)及校准曲线评价模型校准度;应用决策曲线评价模型临床应用价值。通过比较三种Logistic回归模型预测效能和临床应用差异选择最佳建模方法。结果逐步Logistic回归模型结果显示,面部压力性损伤的影响因素为年龄(OR=39.041)、糖尿病(OR=7.256)和单次俯卧位通气时间(OR=6.705);全变量Logistic回归模型结果显示,面部压力性损伤的影响因素为年龄(OR=26.882)、糖尿病(OR=1.770)、ICU住院时间(OR=2.610)和单次俯卧位通气时间(OR=5.340);Lasso-Logistic回归结果显示,面部压力性损伤的影响因素为年龄(OR=38.256)、糖尿病(OR=1.094)、单次俯卧位通气时间(OR=5.738)和Richmond躁动镇静评分(OR=1.179)。Lasso-Logistic回归模型预测俯卧位通气相关面部压力性损伤的AUC、灵敏度和特异度分别为0.855、0.959和0.750,优于逐步和全变量Logistic回归模型;AIC和BIC分别为44.634和55.745,低于逐步和全变量Logistic回归模型;校准曲线显示Lasso-Logistic回归模型预测概率与实际概率拟合效果最佳。决策曲线显示Lasso-Logistic回归模型获得临床收益对应风险阈值为0.01~0.98,优于逐步和全变量Logistic回归模型。结论年龄、糖尿病、单次俯卧位通气时长和Richmond躁动镇静评分是俯卧位通气相关面部压力性损伤的危险因素,Lasso-Logistic回归模型预测效能和临床应用价值优于逐步Logistic回归模型和全变量Logistic回归模型,是最佳建模方法。

儿科手术患者术中获得性压力性损伤风险评估量表的构建及应用研究

目的 构建儿科手术患者术中获得性压力性损伤(IAPI)风险评估量表并探讨其应用效果。方法 选取2022年8月至2023年5月湖南省儿童医院106例儿科手术患者为研究对象,通过文献回顾和德尔菲专家函询,生成IAPI风险评估量表,将函询后生成的量表应用到临床,开展信效度检验及预测IAPI发生的效能。结果 两轮函询结果显示,专家积极性较高、权威程度较高、意见比较集中、一致性较高。最终量表包括手术时间、体位、美国麻醉医师协会分级、营养状态、体重指数、术中受压处皮肤情况、术前肢体活动、组织灌注8个条目,量表Cronbach’s α系数为0.705,分半信度为0.725,问卷水平内容效度指数为0.832,条目水平内容效度指数为0.805~1.000。使用Munro量表作为效标,术前、术中、术后评分的相关系数分别为0.377、0.415、0.513。量表预测IAPI发生的曲线下面积为0.810,灵敏度为70.8%、特异度为81.5%、临界值为13.5分。结论 构建的量表具有较高的权威性和科学性,可作为儿科手术患者IAPI风险的评估工具。

基于多参数优化地理探测器的山洪灾害驱动力分析及风险评价

【目的】大同市地处黄土高原东北边缘,区域内频繁的地下开采活动加剧了山洪灾害,严重威胁人民生命财产安全。为揭示该区域山洪灾害主要驱动力及对其进行风险性评价,【方法】基于大同市山洪灾害调查评价项目成果数据,采用多尺度网格进行采样,并组合参数最优地理探测器对连续型驱动因子进行最优离散化处理,探测分析山洪灾害驱动因子解释力和各驱动因子分级的平均危险度,最后基于所得解释力和危险度进行定量风险性评价。【结果】结果表明:降雨是诱发山洪灾害的首要因素(q=0.088 8),人类活动次之(q=0.061 8),地表环境最弱(q=0.022 7);在所选降雨指标中,6 h强降雨对大同市山洪灾害发生有平均最强解释力(q=0.141 2),可在进一步山洪灾害临界雨量研究中予以考虑;大同市山洪灾害危险水平较高,中高危险区面积占比超3/5,高危险区灾害点密度达0.038 5个/km^(2)。【结论】网格尺度和离散方式的优化选择均可有效提高地理探测器分析结果解释力;短历时(<6 h)强降雨若降雨不能持续,对山洪灾害的诱发力度大打折扣;整体来看大同市山洪灾害危险水平较高,且主要集中分布在易损性水平较低区域。研究结果可为定量进行山洪灾害风险性评价提供参考,为大同市山洪灾害防治区划提供一定的科学依据。

海绵翻身垫联合压疮风险量化评估护理在脑卒中后偏瘫长期卧床患者中的应用

目的探讨海绵翻身垫联合压疮风险量化评估护理干预在脑卒中后偏瘫长期卧床患者中的应用效果,以期为脑卒中后偏瘫长期卧床患者的护理干预方案制定提供参考。方法选取2020年5月—2022年7月于首都医科大学附属北京世纪坛医院就诊的110例脑卒中后偏瘫长期卧床患者,采用随机数字表法分为研究组和对照组,每组55例。对照组患者采用常规护理干预,研究组患者采用海绵翻身垫联合压疮风险量化评估护理干预。比较2组患者干预前后Braden压疮风险评估表得分及干预后压疮发生情况,采用脑卒中病损评估表(SIAS)评估2组患者干预前后的双侧肢体功能,采用舒适状况量表(GCQ)评估2组患者干预前后的舒适状况,采用脑卒中专门化生活质量量表(SS-QOL)评估2组患者干预前后的生活质量。结果研究组患者干预后的Braden评分高于对照组,差异有统计学意义(P<0.05)。研究组患者住院期间的压疮分级低于对照组,差异有统计学意义(Z=0.250,P=0.040);研究组患者住院期间压疮发生率为16.36%(9/55),低于对照组的36.36%(20/55),差异有统计学意义(χ^(2)=5.666,P=0.017)。2组患者干预前SIAS评分比较,差异无统计学意义(P>0.05);2组患者干预后SIAS评分均高于干预前,且研究组患者高于对照组,差异均有统计学意义(P<0.05)。2组患者干预前GCQ评分比较,差异无统计学意义(P>0.05);2组患者干预后GCQ评分均高于干预前,且研究组患者高于对照组,差异均有统计学意义(P<0.05)。2组患者干预前SS-QOL评分比较,差异无统计学意义(P>0.05);2组患者干预后SS-QOL评分均高于干预前,且研究组患者高于对照组,差异均有统计学意义(P<0.05)。结论海绵翻身垫联合压疮风险量化评估护理可有效降低脑卒中后偏瘫长期卧床患者的压疮发生风险,且能有效改善患者肢体功能,并提高患者的舒适度和生活质量,有利于患者的预后康复。

良性肿瘤手术患者发生术中急性压疮的危险因素分析

目的分析探讨良性肿瘤手术患者发生术中急性压疮的危险因素。方法选取2020年5月至2022年5月河南科技大学第一附属医院收治的202例良性肿瘤手术患者作为研究对象,收集患者性别、年龄、体重指数、基础体温、术中有无应用防压疮措施、手术持续时间、既往有无压疮史以及术后6 d内压疮(即术中急性压疮)发生情况等资料,并根据是否发生术中急性压疮将其分为急性压疮组和无急性压疮组,多因素Logistic回归分析良性肿瘤手术患者发生术中急性压疮的相关危险因素。结果202例良性肿瘤手术患者发生术中急性压疮(均为Ⅰ期)28例(13.86%),设为急性压疮组;未发生术中急性压疮174例(86.14%),设为无急性压疮组。单因素分析结果显示,急性压疮组体重指数>25.0 kg/m~2、基础体温>36.5℃、术中未应用防压疮措施、手术持续时间>180 min的患者比例均明显高于无急性压疮组(χ^(2)=110.092、6.542、7.393、76.579,P<0.001、P=0.011、P=0.007、P<0.001);多因素Logistic回归分析结果显示,体重指数>25.0 kg/m^(2)、手术持续时间>180 min是良性肿瘤手术患者发生术中急性压疮的独立危险因素(95%CI为1.137~2.569、1.332-5.871,P均<0.001)。结论良性肿瘤手术患者术中急性压疮的发生与体重指数、手术持续时间密切相关,临床应在术前对患者术中急性压疮发生情况进行风险评估,及时给予相应措施干预,以降低术中急性压疮的发生风险。

PONV风险因素评估量表在预防妇科腹腔镜术后恶心、呕吐中的应用效果

目的探究术后恶心呕吐(PONV)风险因素评估量表在预防妇科腹腔镜术后恶心、呕吐中的应用价值。方法选取84例妇科腹腔镜手术患者,按照随机单盲法分为对照组(40例)与观察组(44例)。对照组采用常规护理,观察组在对照组基础上应用PONV风险因素评估量表。对比两组术后恶心、呕吐发生情况及临床治疗指标。结果观察组患者轻度和中、重度恶心、呕吐占比均低于对照组,无恶心、呕吐占比95.45%高于对照组的60.00%(P<0.05)。观察组术后首次排气时间、下床活动时间、切口愈合时间和住院时间均明显短于对照组(P<0.05)。结论PONV风险因素评估量表在预防妇科腹腔镜术后恶心、呕吐中的应用价值较高,值得临床推广与应用。

Risk factors for pressure ulcers in adult patients of cardiac surgery with cardiopulmonary bypass

Pressure ulcers(PUs)are a common complication of surgery.Despite PUs causing a heavy economic burden and diminishing patients’quality of life,their risk factors have not been thoroughly investigated.We aimed to find risk factors for PUs in adult cardiac surgery patients with cardiopulmonary bypass(CPB).Methods:Demographic,laboratory,and surgical data,the score of pressure ulcer(PU)risk tool-Braden Scale of 2307 adult patients who underwent cardiac surgery with cardiopulmonary bypass(CPB)between January 2019 and September 2019 were obtained.The postoperative PU incidence rates were analyzed using binary logistic regression analysis.Receiver operating characteristic curves(ROC)and the areas under the curves(AUC)were calculated to assess the predictive accuracy of PU risk.Results:Of the 2307 patients in this study,176 developed PUs after surgery,PU incidence rate was 7.6%.Univariate analysis showed that sex,emergency status,surgery type,surgery classification,and skin problems before surgery were risk factors for postoperative PUs.In multivariate analysis,emergency surgery,hemoglobin,hematocrit,pro-brain natriuretic peptide(pro-BNP),surgery classification,and skin problems before surgery were risk factors for postoperative PUs.Conclusions:Our findings suggest that emergency surgery,hemoglobin,hematocrit,pro-BNP,surgery classification,and skin problems before surgery are risk factors for PUs in adult cardiac surgery patients with CPB.The widely used Braden Scale is unsuitable for predicting PUs in such patients.

压疮感染的预防、诊断与治疗要点

压疮合并感染是医院感染的重要组成部分。本文通过回顾文献和最新指南,总结压疮的分类、压疮感染风险评估、压疮感染的临床表现与诊断治疗,为临床压疮感染的预防和治疗提供依据。

Braden QD量表在儿童压力性损伤风险评估中使用的范围综述

目的:对儿童压力性损伤风险评估工具Braden QD量表的使用进行范围审查,剖析该领域相关研究现状、为临床实践及相关研究提供参考和借鉴。方法:检索国内外数据库及相关网站中有关Braden QD量表使用的相关研究,对建库至2023年4月25日的中英文文献进行检索和筛选,对纳入文献进行汇总和分析。结果:检索共获得82篇文献,经筛选最终纳入10篇文献。其中8篇检测了Braden QD量表风险预测效能、2篇文献比较了量表的风险评估准确性及适用性。结论:Braden QD量表预测效能较好,未来本土化的调试和应用需要进一步开展多中心、大样本的临床研究。

侧卧位手术患者术中急性压疮形成的危险因素

目的探讨侧卧位手术患者术中急性压疮形成的危险因素。方法回顾性分析2021年3月至2022年3月于南昌大学第四附属医院行侧卧位手术治疗的118例患者的临床资料,根据是否发生急性压疮将患者分为发生组和未发生组,统计两组患者的基础资料,采用多因素Logistic回归分析探讨侧卧位手术患者发生术中急性压疮的危险因素。结果118例侧卧位手术患者中,13例患者发生术中急性压疮,发生率11.02%。单因素分析结果显示,发生组患者的手术时间≥2h、体质量指数(body mass index,BMI)≥25kg/m^(2)、术前血红蛋白<60g/L、术中无保护措施、术中体温<36℃占比均显著高于未发生组(P<0.05);多因素Logistic回归分析结果显示,手术时间≥2h、BMI≥25kg/m^(2)、术前血红蛋白<60g/L、术中无保护措施、术中体温<36℃均是侧卧位手术患者发生术中急性压疮的独立危险因素(P<0.05)。结论侧卧位手术患者术中易发生急性压疮,手术时间≥2h、BMI≥25kg/m^(2)、术前血红蛋白<60g/L、术中无保护措施、术中体温<36℃均是其独立危险因素,临床可针对高危因素制定干预措施,以降低压疮发生率。

术前高危影响因素分析及Braden-Q+P评分量表预防评估对儿童先心病术中压疮风险防范研究

目的:研究术前高危影响因素分析及Braden-Q+P评分量表预防评估对儿童先心病术中压疮风险防范效果。方法:回顾性分析本院2019年1月至2022年3月行手术治疗的88例先天性心脏病患儿临床资料,依据手术室护理模式分为两组各44例。对照组实施传统手术室护理,观察组实施术前高危影响因素分析及Braden-Q+P评分量表预防评估的手术室护理,比较两组患儿术中压疮发生率、术中低体温发生率、术中低血压发生率、生命体征指标(收缩压、舒张压、心率)、患儿家长的护理总满意率差异。结果:观察组的术中压疮发生率、术中低体温发生率、术中低血压发生率低于对照组(P<0.05),术毕的生命体征指标、患儿家长的护理总满意率高于对照组(P<0.05)。结论:术前高危影响因素分析及Braden-Q+P评分量表预防评估可以降低儿童先心病术中压疮、术中低体温、术中低血压的发生风险,融洽护患关系。

中国46所三级医院成年住院患者压力性损伤流行病学特征及Braden量表预测作用研究

背景Braden量表是全球公认的有良好信效度的压力性损伤危险预测工具,但因应用人群不同,其最佳预测界值也存有争议。该量表在我国临床应用的预测界值为≤16分,欧美国家多以≤18分为界值,但其在我国住院患者中的预测作用的研究较少。目的横断面调研全国13个省/自治区、46所三级医院成年住院患者压力性损伤的流行病学特征,分析Braden量表及其6个分量表预测压力性损伤发生的效能及其最佳界值。方法由解放军东部战区总医院负责成立多中心合作研究课题组,在全国公开招募≥500张床位的三甲医院,经过资格审查和签订合作研究双向协议后,共纳入13个省/自治区、46所符合条件的医院作为多中心研究单位,纳入住院时间≥24 h、年龄≥18岁的患者为研究对象。入选护龄≥2年的伤口护理骨干护士作为调研人员,共入选1060名调研护士。在2021-03-30和2021-05-29,使用专用调查记录表记录患者的一般情况;检查全身皮肤,判断是否发生压力性损伤及分期情况;采用Braden量表(从感知觉、潮湿度、活动能力、移动能力、营养、摩擦和剪切力6个分量表逐项评分)判断压力性损伤的发生危险。绘制受试者工作特征(ROC)曲线,分析Braden量表及其6个分量表预测成年住院患者发生压力性损伤的效能及其最佳界值。结果本次调研共获得60555例有效数据,其中压力性损伤现患率为1.67%(1010/60555),医院获得性压力性损伤现患率为0.74%(448/60555)。男性压力性损伤现患率〔2.08%(677/32518)〕高于女性〔1.19%(333/28037)〕(χ^(2)=73.394,P<0.001)。≥80岁和ICU患者压力性损伤现患率最高,分别为5.98%(311/5198)和10.58%(324/3061)。多因素Logistic回归分析结果显示,年龄、性别、血清白蛋白、血红蛋白、失禁类型、卧床、Braden量表总分是成年住院患者发生压力性损伤的影响因素(P<0.05)。Braden量表预测成年住院患者发生压力性损伤的ROC曲线下面积(AUC)为0.95〔95%CI(0.94,0.95)〕,灵敏度和特异度分别为96%和83%,约登指数为0.79,对应的最佳界值为17.50分。Braden量表预测不同科室和年龄患者发生压力性损伤的AUC为0.78~0.97,灵敏度为83%~97%,特异度为61%~91%,约登指数为0.47~0.88,最佳界值为13.5~18.5分。摩擦和剪切力、移动能力和活动能力3个分量表预测成年住院患者压力性损伤发生危险的AUC分别为0.87、0.84、0.80,约登指数分别为0.56、0.56、0.54,最佳界值分别为1.50、2.50、1.50分。结论本次调研得出我国13个省/自治区、46所三级医院成年住院患者压力性损伤现患率为1.67%(1010/60555),医院获得性压力性损伤现患率为0.74%(448/60555)。Braden量表适用于我国三级医院住院患者预测压力性损伤发生危险,总分≤18分有更好的预测作用,其中摩擦和剪切力、移动能力和活动能力分量表的预测作用最大,在人员紧张或特殊环境下可采用此3个分量表预测压力性损伤危险,最佳界值的预测作用需在应用中进一步验证。

ICU患者压力性损伤风险评估工具准确性的网状Meta分析

目的评价不同压力性损伤风险评估工具对ICU患者压力性损伤风险预测的准确性,为准确筛查ICU压力性损伤风险患者提供依据。方法计算机检索PubMed、Cochrane Library、CINAHL、EMbase、Web of Science、中国知网、维普网、万方数据和中国生物医学文献服务系统中ICU患者压力性损伤风险评估工具相关研究,经文献筛选、质量评价、资料提取后,采用ANOVA模型实现基于贝叶斯方法的诊断实验准确性网状Meta分析。结果共纳入28篇文献,共计11221例患者,涵盖12个压力性损伤风险评估工具。Meta分析结果显示,改良版Cubbin&Jackson量表优势指数最高,灵敏度[0.72,95%CI(0.59,0.82)],特异度[0.75,95%CI(0.63,0.84)],其次为EVARUCI量表,灵敏度[0.75,95%CI(0.54,0.90)],特异度[0.65,95%CI(0.42,0.83)];Braden量表优势指数最低,灵敏度[0.66,95%CI(0.62,0.71)],特异度[0.58,95%CI(0.54,0.61)]。结论改良版Cubbin&Jackson量表、EVARUCI量表具有较好的诊断试验准确性,临床医护人员评估ICU患者压力性损伤风险时可优先选用。

基于Braden-Q儿童压疮评估表的预防性护理干预策略在隐匿性阴茎术后患儿中的应用

目的:观察基于Braden-Q儿童压疮评估表的预防性护理干预策略对隐匿性阴茎(CP)术后患儿的影响。方法:选取2020年1月—2021年12月厦门大学附属第一医院收治的100例CP患儿作为研究对象,以入院顺序分为两组,各50例。对照组采取常规压疮护理,观察组采取基于Braden-Q儿童压疮评估表的预防性护理干预。比较两组压疮发生风险、营养风险、压疮发生率。结果:干预前,两组Braden-Q儿童压疮评估表中各项评分比较,差异无统计学意义(P>0.05);干预5 d后,两组Braden-Q儿童压疮评估表中各项评分均高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组压疮发生率为8.00%,低于对照组的24.00%,差异有统计学意义(P<0.05)。干预前,两组营养风险评估量表(NRS)评分比较,差异无统计学意义(P>0.05);干预5 d后,两组NRS评分低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论:基于Braden-Q儿童压疮评估表的预防性护理干预策略能降低CP患儿术后压疮发生风险和压疮发生率,能改善患儿压疮严重程度,同时能提升患儿营养水平,加速患儿康复。

成人ICU压力性损伤风险评估量表的研究进展

对成年重症监护室(ICU)病人进行精准压力性损伤风险评估是实施早期个体化护理的关键,然而在国内还没有一个公认的适用于成人的ICU压力性损伤风险评估量表。该文对国内外常用的ICU压力性损伤评估量表的内容、评估效果、优缺点进行了总结和概括,旨在为ICU护理人员选择合适的压力性损伤风险评估工具和研究成人ICU压力损伤风险评估量表提供参考。