Zhongguo quanke yixue (Jun 2023)
Pressure Injuries among Adult Inpatients in 46 Tertiary Hospitals in China: Epidemiological Characteristics and Predictive Value of the Braden Scale
Abstract
Background The Braden Scale is a globally recognized pressure injury risk prediction tool with good reliability and validity. However, due to different application populations, its optimal cut-off value is controversial. The optimal cut-off value of the scale in clinical application in China is ≤ 16 points, while most European countries and the US take ≤18 points as the cut-off value. There is insufficient research on the predictive value of the scale in hospitalized patients in China. Objective To carry out a cross-sectional study on the epidemiological characteristics of pressure injuries among adult inpatients in 46 tertiary hospitals in 13 provinces/autonomous regions across China, and to examine the predictive values and optimal cut-off values of the Braden Scale and its six subscales. Methods Established by the Eastern Theater General Hospital, the research group of this multicenter study publicly recruited 46 eligible grade A tertiary hospitals containing at least 500 beds in 13 provinces/autonomous regions of China as the multicenter research settings after qualification review and signing a bilateral agreement on participating in the research. Adult patients (≥18 years old) with hospitalization time ≥24 hours were included as the patient participants, and senior wound care nurses with at least two years of working experience (n=1 060) were included as investigators. On March 30 and May 29, 2021, the nurses used a special survey record form to record the general situation of the patients, and checked their skin of the whole body to find out if there was a pressure injury, and used the six subscales of the Braden Scale (sensory perception, moisture, activity, mobility, nutrition, friction and shear) to assess the risk of pressure injuries. ROC curves of the scale and its subscales were plotted to assess their predictive values and optimal cut-off values for pressure injuries. Results In total, the valid data of 60 555 patients were obtained. The prevalence of pressure injuries, and hospital-acquired pressure injuries was 1.67% (1 010/60 555), and 0.74% (448/60 555), respectively. The prevalence of pressure injuries in males was higher than that of females〔2.08% (677/32 518) vs 1.19% (333/28 037) 〕 (χ2=73.394, P<0.001). And the prevalence of pressure injuries in those hospitalized in the ICU〔10.58% (324/3 061) 〕 and those aged 80 years and over was higher〔5.98% (311/5 198) 〕. Logistic regression analysis showed that age, sex, serum albumin, hemoglobin, incontinence type, bed rest and Braden score were associated with pressure injuries (P<0.05). The area under the ROC curve (AUC) of the Braden Scale for predicting pressure injuries was 0.95〔95%CI (0.94, 0.95) 〕, with 96% sensitivity and 83% specificity, and 0.79 Youden index, as well as its corresponding optimal cut-off value of 17.50 points. In assessing the risk of pressure injuries in patients in different departments and age groups, the AUC of the Braden Scale ranged from 0.78 to 0.97, with a sensitivity ranging from 83% to 97%, a specificity ranging from 61% to 91%, and the Youden index ranged from 0.47 to 0.88, the optimal cut-off value ranged from 13.50 to 18.50 points. The AUC of the friction and shear predicting the risk of pressure injuries was 0.87, with 0.56 as the Youden index, and 1.50 points as its associated optimal cut-off value, and the AUC of mobility was 0.84, with 0.56 as the Youden index, and 2.50 points as its associated optimal cut-off value, and the AUC of activity was 0.80, with 0.54 as the Youden index, and 1.50 points as its associated optimal cut-off value. Conclusion The prevalence of pressure injuries, and hospital-acquired pressure injuries among adult inpatients in 46 tertiary hospitals in 13 provinces/autonomous regions across China is 1.67% (1 010/60 555), and 0.74% (448/60 555), respectively. The Braden Scale is applicable to adult inpatients in tertiary hospitals in China. The total score ≤18 points may be the optimal cut-off. Three subscales, namely friction and shear, mobility and activity have higher predictive values. In case of insufficient medical workers or special settings, the three subscales can be used to predict the risk of pressure injury, but their optimal cut-off values still need to be further verified in applications.
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