台灣醫療院所壓瘡風險評估工具之臨床效度

Validity of Assessment Tools for Risk Factors of Pressure Ulcers in Taiwan

于博芮(Po-Jui Yu) ； 李世代(Shyh-Dye Lee) ； 林壽惠(So-Hui Lin)

《台灣老年醫學雜誌》 1卷2期 (2005/11) Pp. 79-88

https://doi.org/10.29462/TGG.200511.0004

摘要

目的：本研究乃比較不同之壓瘡風險評估工具在國內的臨床效度（敏感度和特異性），以及既有判定標準或界定切點之合理可用性，並提供臨床實務上應用之參考。
方法：本研究透過橫斷式之調查法，在台灣地區北部、中部、南部及東部，各依人口分佈分層抽樣選取一到三所醫療機構，共九所作為研究之場所及對象。研究團隊至各選定之醫療機構以當日之住院病患為收案對象，並由兩名經過訓練的護理人員陪同研究團隊參與進行樣本對象皮膚完整性之檢視，同時登錄個案相關之基本資料。除了蒐集個案人口學、皮膚狀態、傷口及其他等基本屬性資料之外，並參考使用現行較具代表性之壓瘡風險評估工具，包括有Braden量表、Norton量表、Gosnell量表及Waterlow量表等，再將結果集中查核、整理、分析及比較其臨床之效度。
結果：總共收集了2,619位住院病患作為研究樣本，病患至研究調查日當天住院日數之中位數約為6天左右；而數種壓瘡風險評估工具中依現行判定標準或界定切點以Braden及Norton量表之敏感度及特異性均較高，Braden量表之敏感度為88.0%，特異性為75.1%，Norton量表之敏感度為86.1%，特異性為75.0%；而Gosnell量表之敏感性較差，僅達46.3%，Waterlow量表特異性亦較差，為31.7%。
結論：以Braden及Norton量表做為壓瘡臨床之初步評估工具或指標，依現行判定標準或界定切點有其適用度或可用性；並建議成立更重要之壓瘡評估小組，針對壓瘡介入措施進一步規劃提供完整之處置準則，以提供各級醫療機構對於處理壓瘡之參考。

關鍵字

壓瘡 ； 風險 ； 醫療機構

並列摘要

Objectives: This study strives to establish the clinical validity (sensitivity and specificity), and the pertinency of current cutoff point(s) of theirs by applying currently various assessment tools of pressure ulcers, in order to propose more ideal tool(s) for clinical applications in Taiwan.
Methods: This study conducted at 9 health care facilities, i.e. 1 to 3 hospitals stratifiedly sampling from northern, central, southern and eastern Taiwan. The samples were selected from the hospitalized patient lists right on the day of surveillance. Two well-trained nurses were invited to join the investgating team to review the skin integrity of the study samples, and to collect the related health profile at the same time. In addition to completing standardized questionnaire kits including demographics, skin assessment of high risk factors, wound, and others. Study tools such as Braden, Norton, Gosnell and Waterlow scales were applied concurrently. Collected data were audited and submitted to a central site for data-base entry and analysis.
Results: A total of 2,619 patients were recruited. The median length of stay of samples upto the day of surveillance in the health care facilities studied was around 6 days. Based on current cutoff points, Braden and Norton scales in the current assessment tools of pressure ulcers were shown to possess relatively higher sensitivity and specificity from our study. The sensitivity and specificity for Braden scale was 88.0% and 75.1%; for Norton scale, 86.1% and 75.0%, respectively. The sensitivity of Gosnell was not good, 46.3%. The specificity of Waterlow was lower, 31.7%.
Conclusion: Braden and Norton scales would be two optimal choices for the initial assessment on pressure ulcers in Taiwan, and their currently available cutoff points were still appropriate. Besides, further grand panel was also indicated to organize a corresponding guideline for the the benchmarks of intervention strategy/tactic on the pressure ulcers.

並列關鍵字

pressure ulcer/sore ； risk factor ； health care facility