Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers |
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| Authors: | Lisette Schoonhoven Jeen R E Haalboom Mente T Bousema Ale Algra Diederick E Grobbee Maria H Grypdonck Erik Buskens |
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| Affiliation: | aJulius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, Netherlands, bDepartment of Internal Medicine, University Medical Centre Utrecht, cDepartment of Dermatology, Eemland Hospital, PO Box 1502, 3800 BM, Amersfoort, Netherlands |
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| Abstract: | ObjectiveTo evaluate whether risk assessment scales can be used to identify patients who are likely to get pressure ulcers.DesignProspective cohort study.SettingTwo large hospitals in the Netherlands.Participants1229 patients admitted to the surgical, internal, neurological, or geriatric wards between January 1999 and June 2000.Results135 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.ConclusionAlthough 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. What is already known on this topicThe incidence of pressure ulcers in hospitalised patients varies between 2.7% and 29.5%Guidelines for prevention of pressure ulcers base the allocation of labour and resource intensive measures on the outcome of risk assessment scalesMost risk assessment scales are based on expert opinion or literature review and have not been evaluatedThe sensitivity and specificity of risk assessment scales varyWhat this study addsThe effectiveness of available risk assessment scales is limitedUse of the outcome of risk assessment scales leads to inefficient allocation of preventive measures |
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