Development and validation of CAVE score in predicting presence of pressure ulcer in intensive care patients

Abstract

Background Pressure ulcers (PUs) are one of the quality care indicators in nursing care. They are considered to primarily be preventable. Early identification of the patients most at risk particular for critically ill patients is crucial for providing prompt care. Several tools have been developed to support healthcare providers, but their validities are limited in Thailand. Development of tools with better performance is essential. Aims To develop and validate a PU risk assessment tool with good diagnostic properties in intensive care units (ICUs). Methods A prospective study was conducted in ICUs of a tertiary care hospital, Thailand from January 2019 to April 2020. Baseline data were collected at admission to the ICUs. Skin assessment was evaluated every 24 h. Data were divided into two sets: model development and model validation. Creating a risk score which was derived from multivariate methods were performed. Youden index were used to determine the optimal cut-off point. Then, the other dataset was used to validate the risk score. Receiver Operating Characteristic (ROC) curves was used to demonstrate the performance of the test. Results The study included 288 and 270 patients for development and validation models. The risk score consisted 4 clinical factors; presence of Cardiovascular disease, low serum Albumin, having Ventilated, and Edema (CAVE score). The area under the ROC curve (AUC) was 0.8 and a score at 2.5 was the best cut-off point. The AUC in the validation group was 0.6, age<60 years was 0.78, and age≥60 years was 0.57. Conclusion The predictive validity of the CAVE score is limited but comparable to the existing tools in Thailand. However, it has a good diagnostic property in young patients. The CAVE score could be considered as an alternate screening tool in critical care setting particularly for young patients.

Selected Biochemical Blood Parameters and a Risk of Pressure Ulcers in Patients Receiving Treatment in Intensive Care Units

“…The instrument enabling evaluation of pressure ulcer risk takes into account the following factors: condition of the cardiovascular system, serum albumin level, application of mechanical ventilation and presence of oedema. The authors suggest that assessments based on the CAVE scale could effectively be performed by nursing personnel in clinical practice at ICUs [ 21 ]. Higher albumin levels corresponded to higher ratings achieved on the Braden Scale.…”

“…Higher albumin levels corresponded to higher ratings achieved on the Braden Scale. There is no perfect method of assessing pressure ulcer risk; however, evaluation based on the Braden Scale takes into account patients’ nutritional status; the tool has been validated and it is preferred in assessing patients in the ICU [ 19 , 20 , 21 , 22 , 23 ].…”

Singular Predictors of Hospital-Acquired Pressure Injuries Under Intensive Care: A Retrospective Cohort Study in a Medium-Complexity Hospital

“…Higgins et al (2020) considered that differences in the pathophysiology of specific diseases may have an impact on research, resulting in variations in the weight of risk predictors for HAPI. In highly specialized services (as presented by Ninbanphot et al, 2020), the predictors may be different from ours; therefore, knowing the population and profile of a health care unit becomes imperative in the risk assessment for HAPI and in choosing the prediction scale that best suits each ICU. The gaps presented in the literature reinforce the need for additional studies to understand the events and factors that culminate in HAPI development.…”

“…Such risk factors are important HAPI predictors for ICU patients, and their inclusion in the risk assessment tools tends to make the estimates more accurate compared to those provided by generalist tools such as Braden, for example, which does not take into account the use of vasopressors or length of stay (Argenti et al, 2020; Miller et al, 2020; Sala et al, 2021). Specific risk scales for HAPI in the ICU, such as Jackson and Cubbin (Higgins et al, 2020), Sanada (Sanada et al, 2008), and CAVE (Ninbanphot et al, 2020), do not consider the time effect of length of stay in the ICU, the period of time under invasive mechanical ventilation, or the period of norepinephrine administration (at most, they consider presence/absence of vasopressor drugs).…”

Translation and piloting of the Chinese Mandarin version of an intensive care-specific pressure injury risk assessment tool (the COMHON Index)

“…Recently, more ICU-specific tools have been developed and tested to some extent [e.g. [19] , [20] , [21] ]. Many tools are tested using predictive validity (i.e.…”