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A risk assessment scale for the prediction of pressure sore development: reliability and validity
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
2002 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 38, no 2, 190-199 p.Article in journal (Refereed) Published
Abstract [en]

Background. The ability to assess the risk of a patient developing pressure sores is a major issue in pressure sore prevention. Risk assessment scales should be valid, reliable and easy to use in clinical practice.

Aim.  To develop further a risk assessment scale, for predicting pressure sore development and, in addition, to present the validity and reliability of this scale.

Methods. The risk assessment pressure sore (RAPS) scale, includes 12 variables, five from the re-modified Norton scale, three from the Braden scale and three from other research results. Five hundred and thirty patients without pressure sores on admission were included in the study and assessed over a maximum period of 12 weeks. Internal consistency was examined by item analysis and equivalence by interrater reliability. To estimate equivalence, 10 pairs of nurses assessed a total of 116 patients. The underlying dimensions of the scale were examined by factor analysis. The predictive validity was examined by determination of sensitivity, specificity and predictive value.

Results.  Two variables were excluded as a result of low item–item and item–total correlations. The average percentage of agreement and the intraclass correlation between raters were 70% and 0·83, respectively. The factor analysis gave three factors, with a total variance explained of 65·1%. Sensitivity, specificity and predictive value were high among patients at medical and infection wards.

Conclusions.  The RAPS scale is a reliable scale for predicting pressure sore development. The validity is especially good for patients undergoing treatment in medical wards and wards for infectious diseases. This indicates that the RAPS scale may be useful in clinical practice for these groups of patients. For patients undergoing surgical treatment, further analysis will be performed.

Place, publisher, year, edition, pages
2002. Vol. 38, no 2, 190-199 p.
Keyword [en]
pressure sore, risk assessment, prevention, validity, reliability, instrument development
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-24809DOI: 10.1046/j.1365-2648.2002.02163.xLocal ID: 7076OAI: oai:DiVA.org:liu-24809DiVA: diva2:245132
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Pressure sores: risk assessment and prevention
Open this publication in new window or tab >>Pressure sores: risk assessment and prevention
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aims of this thesis were to study the prevalence, incidence, prevention and treatment of pressure sores, to further develop a risk assessment scale, and test the reliability and validity of this scale, to identify risk factors for pressure sore development, and to study skin blood flow in non-blanchable erythema areas as compared to undamaged skin.

Criteria used for pressure sore assessment were persistent discoloration i.e. non-blanchable erythema, epithelial damage, and damage to the full thickness of the skin either without or with a deep cavity. The prevalence study was based on interviews, with 55 registered nurses, about 1173 patients. A Risk Assessment Pressure Sore scale, i.e. the RAPS scale consisting of twelve variables: general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, :fiiction and shear, skin type, bodily constitution, body temperature and serum albumin, was developed. In total 530 patients were assessed with the RAPS scale within 24 hours of admission, thereafter once a week for a maximum of twelve weeks. To estimate equivalence, 10 pairs of nurses assessed a total of 116 patients. A total of 19 blood flow measurements, in 5 patients were performed, using a Laser Doppler perfusion imager.

The prevalence of pressure sores among 1173 patients was 3.75% and the incidence among 530 patients was 11.75%. The most frequently preventive and treatment measures used were related to pressure relief. After the test of internal consistency, two variables were excluded from the RAPS scale, namely bodily constitution and skin type. The Cronbach's alpha coefficient was 0.83. The factor analyses gave three factors, termed mobility, physical condition and nutrition, with a total variance explained of 65.1%. The intraclass correlation between raters was 0.83. Sensitivity was 75% and specificity 70% among patients on medical wards and corresponding values for patients on infection wards were 80% and 69.7%, respectively. In the multiple logistic regression analyses mobility, length of hospitalisation, age, surgical treatment and weight were identified as risk factors for pressure sore development. The blood flow distribution profiles for areas with non-blanchable erythema and those for undamaged skin were found to be different. As the area of non-blanchable erythema decreased, the blood flow distribution profiles gradually became more homogeneous.

In conclusion, pressure sores are still a problem in nursing care. The RAPS scale is a reliable scale for predicting pressure sore development. The validity is especially good for patients on medical wards and infection wards. The results indicate that the scale may be useful in clinical practice. Mobility is a major risk factor and undergoing surgical treatment increases the risk of developing pressure sores. There are differences between blood flow in areas of non-blanchable erythema as compared to undamaged skin. The skin blood flow seems to increase in relation to the size of the non-blanchable erythema.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2003. 64 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 784
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27514 (URN)12170 (Local ID)91-7373-542-6 (ISBN)12170 (Archive number)12170 (OAI)
Public defence
2003-04-29, Berzeliussalen, Hälsouniversitetet, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-09Bibliographically approved

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Lindgren, MargaretaUnosson, MitraKrantz, Ann-MargretEk, Anna-Christina

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