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

Abstract 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 g...

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Bibliographic Details
Published in:BMJ 2002-10, Vol.325 (7368), p.797-800
Main Authors: Schoonhoven, Lisette, Haalboom, Jeen R E, Bousema, Mente T, Algra, Ale, Grobbee, Diederick E, Grypdonck, Maria H, Buskens, Erik
Format: Article
Language:English
Subjects:
Adult
Aged
Assessed values
Calculators
Cohort Studies
Hospital admissions
Hospital units
Humans
Middle Aged
Nurses
Observational research
Predisposing factors
Pressure ulcer
Pressure Ulcer - etiology
Pressure Ulcer - prevention & control
Prospective Studies
Risk analysis
Risk Assessment
Risk Factors
Sensitivity and Specificity
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Summary:Abstract 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.
ISSN:0959-8138
1468-5833
1756-1833
DOI:10.1136/bmj.325.7368.797