Pressure sore risk calculators: some methodological issues

Edwards, Margaret

doi:10.1111/jocn.1996.5.5.307

Cited by 33 publications

(18 citation statements)

References 21 publications

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“…The use of sensitivity and specificity is widely accepted as mean of assessing the validity of pressure ulcer risk assessment scales (Edwards 1996). Sensitivity of a diagnostic test is the extent to which a true characteristic is classified correctly.…”

Section: Introductionmentioning

confidence: 99%

Pressure ulcers: validation of two risk assessment scales

Defloor¹,

Grypdonck²

2005

Journal of Clinical Nursing

129

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The effectiveness of the Norton and Braden scales is very low. Much needless work is done and expensive material is wrongly allocated. The use of effective preventive measures decreases the predictive value of the risk assessment scales. Although the performance of the risk assessment scales is poor, using a risk assessment tool seems to be a better alternative than relying on the clinical judgement of the nurses.

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Section: Introductionmentioning

confidence: 99%

Pressure ulcers: validation of two risk assessment scales

Defloor¹,

Grypdonck²

2005

Journal of Clinical Nursing

129

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“…The results varied, and little evidence of predictive value or accuracy of the scales was available. 3 9 12 13 – 15Moreover, most of the studies had methodological limitations12: they were small and conducted in varying populations. Also, in some studies the nurse was not blinded when doing the scoring nor were the results adjusted to take account of preventive measures.…”

Section: Introductionmentioning

confidence: 99%

Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers

Schoonhoven

2002

BMJ

134

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Objective To evaluate whether risk assessment scales can be used to identify patients who are likely to get pressure ulcers. Design Prospective cohort study. Setting Two large hospitals in the Netherlands. Participants 1229 patients admitted to the surgical, internal, neurological, or geriatric wards between January 1999 and June 2000. Main outcome measure Occurrence of a pressure ulcer of grade 2 or worse while in hospital. Results 135 patients developed pressure ulcers during four weeks after admission. The weekly incidence of patients with pressure ulcers was 6.2% (95% confidence interval 5.2% to 7.2%). The area under the receiver operating characteristic curve was 0.56 (0.51 to 0.61) for the Norton scale, 0.55 (0.49 to 0.60) for the Braden scale, and 0.61 (0.56 to 0.66) for the Waterlow scale; the areas for the subpopulation, excluding patients who received preventive measures without developing pressure ulcers and excluding surgical patients, were 0.71 (0.65 to 0.77), 0.71 (0.64 to 0.78), and 0.68 (0.61 to 0.74), respectively. In this subpopulation, using the recommended cut-off points, the positive predictive value was 7.0% for the Norton, 7.8% for the Braden, and 5.3% for the Waterlow scale. Conclusion Although risk assessment scales predict the occurrence of pressure ulcers to some extent, routine use of these scales leads to inefficient use of preventive measures. An accurate risk assessment scale based on prospectively gathered data should be developed.

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“…Only secondary investigations inside these institutions can answer whether these striking differences are caused by a different distribution of risk factors or differences in the quality of nursing. Pressure sore risk calculators, facilitating and standardizing the process of risk assessment, have assumed a cardinal role in the prevention and management of pressure sores [7,8,15,20]. The most widely used are the Norton scale [33] and the Braden scale [10].…”

Section: Discussionmentioning

confidence: 99%

“…It is widely accepted that pressure sores can be successfully prevented by the early use of risk assessment scores, modification of intrinsic and extrinsic risk factors for the patient, consistent monitoring and the appropriate utilization of various prophylactic procedures [2,16,20,21,26,27,30] and that pre-existing sores can be treated effectively by conservative or surgical intervention [2,21,28,30]. Therefore, from the medicolegal point of view, the occurrence of a pressure sore in a resident of a senior citizen's home or nursing home as well as in a hospitalized patient can be considered as a nursing injury.…”

Section: Introductionmentioning

confidence: 99%

Pressure sores: epidemiology, medico-legal implications and forensic argumentation concerning causality

Tsokos

Heinemann

Püschel

2000

International Journal of Legal Medicine

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The aim of the present investigation was to identify the frequency and grading of pressure sores in a large series of unselected consecutive deceased subjects before cremation and to discuss aspects of the forensic argumentation concerning causality. A total of 10,222 corpses were examined prospectively over a 1-year-period (1998) for the occurrence, localization and grading of pressure sores. Epidemiological aspects (e.g. age, sex, underlying and contributing causes of death, place of death etc.) were taken from the death certificate. The mean prevalence of pressure sores was 11.2% (87.1% isolated sores; predominant localization of advanced grades on the sacrum in 69.6%). There was a positive correlation between the prevalence of sores and advanced age resulting in a clear female predominance in the age group of 80 years and over because of differences in life expectancy. A significant correlation was found between the prevalence of pressure sores and certain underlying diseases, e.g. trauma, senile dementia, neurological diseases, apoplexy and marasmus. Pressure sores of all grades were more frequently found in the deceased when a senior citizen's or nursing home was given on the death certificate as the domicile in the last period of life. The forensic argumentation for the causal relationship of a pressure sore as the focus of fatal infectious complications or septicemia has to be based on the results of clinical expertises and forensic investigations (evaluation of the institutional documentation of the patient's course, autopsy findings, histology, immunohistochemistry). The vast majority of physicians seem to pay only little attention to the potentially fatal outcome of pressure sores and fatalities associated with this condition are clearly underreported. From the point of view of social medicine, the prevalence of pressure sores in a defined population can be seen as a parameter for the quality of nursing and medical care. In bringing these fatalities to light, the field of legal medicine contributes to a general quality control of standards of nursing and medical care.

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Pressure sore risk calculators: some methodological issues

Cited by 33 publications

References 21 publications

Pressure ulcers: validation of two risk assessment scales

Pressure ulcers: validation of two risk assessment scales

Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers

Pressure sores: epidemiology, medico-legal implications and forensic argumentation concerning causality

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