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[Use of risk scales for decubitus ulcers as screening instruments--A systematic review of external evidence]
1Wissenschaftliche Mitarbeiterin, Universität Hamburg. Gabi_Schloemer@uni-hamburg.de
Context:
Reports on the preventive effects of scales to measure the risk of decubitus ulcer development of patients in various care settings have been inconsistent. The value of the different tools as screening instruments for risk factors as one step of a screening program has not yet been evaluated.
Objective:
To evaluate the prognostic validity of scales measuring the risk of decubitus ulcer development.
Data Sources:
Studies published in English or German and reporting trials of validity and reliability of scales measuring the risk of decubitus ulcer of patients in any care setting were identified through searches of Medline and CINAHL, Carelit and Heklinet (1981-2000). Reference lists of earlier reviews were checked.
Study Selection:
257 abstracts were screened; 43 publications were assessed initially, 24 publications were analysed after exclusion criteria have been applied.
Data Extraction:
Abstracts were screened and data on study objective, scale, cut-off, follow-up, population, setting, sensitivity and specificity, trial quality including blinding, reference standard and outcome measurement were assessed.
Data Synthesis:
24 studies analysed five instruments. Due to heterogeneity in study design, methodological quality and outcome assessment pooling of data was not feasible. Only data on the Braden Scale allowed the calculation of likelihood ratios for each point of the scale. Likelihood ratios for the Braden Scale were moderate [LR+ 0.3-7.7 (Cut-off 16)], and fair for the Norton Scale [LR+ 1.4-2.8 (Cut-off 14)].
Conclusion:
The tools investigated as instruments of primary prevention of decubitus ulcers show that their test performance is inadequate. Thus, they are unlikely to be effective as screening instruments for any institutionalised patient group and care setting.