The Shieh Score as a Risk Assessment Tool for Hospital-Acquired Pressure Injuries: A Retrospective Cohort Study

Abstract

OBJECTIVE To design a new risk assessment tool to identify patients at high risk for hospital-acquired pressure injuries. METHODS The researchers developed the Shieh Score using retrospective data of 406,032 hospital admissions from January 2014 to December 2016 with 1,299 pressure injury cases from the pressure injury registry. A decision tree and best subset logistic regression were used to select predictors from demographic and clinical candidate variables, which were then used to construct the Shieh Score. RESULTS The final Shieh Score included the following measures: sex, age, diabetes, glomerular filtration rate, albumin level, level of function, use of IV norepinephrine, mechanical ventilation, and level of consciousness. The Shieh Score had a higher Youden Index, specificity, and positive predictive value than the Braden Scale. However, the Braden Scale had a higher sensitivity compared with the Shieh Score. CONCLUSIONS The Shieh Score is an alternative risk assessment tool that may effectively identify a smaller number of patients at high risk for hospital-acquired pressure injuries with a higher specificity and positive predictive value than the Braden Scale.

The Shieh Score as a Risk Assessment Instrument for Reducing Hospital-Acquired Pressure Injuries

“…Nevertheless, the reduction in this study's HAPIs indicates that the Shieh Score has the potential to predict PI risk and prevent HAPIs when combined with early alert systems and standardized preventive interventions. It is possible that there would also be a reduction in the rate of HAPIs if the Braden Scale utilized the same early warning notification system and the same standard order set with a Braden Scale score of 18 or less 16,21. Even so, we assert that combining the Braden Scale with the early warning notification system and standard order set would fundamentally change the core design and intent of the Braden Scale.…”

“…16 The Shieh Score consisted of 9 criteria, which were derived from a combination of decision tree and logistic regression, and then validated internally. 16,20 It was originally tested on nonpregnant, adult patients admitted to the hospital for 48 hours or more. One point is given for each of the following criteria: (1) 60 years and older, (2) male sex, (3) diagnosis of type 1 or type 2 DM, (4) GFR less than 30 mL/min, (5) albumin level less than or equal to 2.0 (6) one or more doses of intravenous norepinephrine, and (5) use of mechanical ventilation (Table 1).…”

“…22 The 2-hour time frame has also been recommended by the Agency for Healthcare Research and Quality. 23 16 We used electronic health records and research data warehouse to capture demographic, pharmacy, laboratory, and utilization data. Data from a PI registry were used to iden-tify HAPI cases.…”

“…In contrast, the Braden Scale had a higher sensitivity than the Shieh Score sensitivity. 16 Findings from several studies indicate that firstline nurses do not consistently use the different Braden Scale risk categories; we focused mainly on a comparison between a Shieh Score greater than 4 and a Braden Scale of less than 18. 12,[17][18][19] Thus, the purpose of this study was to evaluate the Shieh Score's influence on the rate of HAPIs when combined with an early warning notification system and standard order set of preventative measures.…”

“…The Shieh Score includes the following criteria: age, sex, diabetes mellitus (DM), glomerular filtration rate (GFR), albumin, use of intravenous norepinephrine, mechanical ventilation, level of function (LOF), and level of consciousness (LOC). 16 The Shieh Score is intended to apply to acutely and critically ill patients receiving care in an acute care facility (hospital). Use of intravenous norepinephrine and mechanical ventilation is limited to critical care patients and they tend to have higher scores than acutely patients not receiving care in an intensive care unit.…”