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Predicting pressure ulcers: cases missed using a new clinical prediction rule
Lisette Schoonhoven1, Diederick E Grobbee, Mente T Bousema
1Centre for Quality of Care Research, Department of Nursing Science, University Medical Centre Nijmegen, Nijmegen, The Netherlands.
Insights
This study found no clear characteristics to distinguish patients misclassified as not at risk for pressure ulcers. Improving prediction accuracy for hospital-acquired pressure ulcers remains challenging with current clinical data.
Area of Science:
- Clinical Nursing Research
- Patient Safety
- Predictive Analytics in Healthcare
Background:
- Hospitalized patients are susceptible to developing pressure ulcers.
- A recent prediction rule can identify most at-risk patients, but up to 30% may still be misclassified.
- Understanding misclassification is crucial for enhancing patient care and preventing hospital-acquired conditions.
Purpose of the Study:
- To describe patients with pressure ulcers incorrectly classified as 'not at risk' by a prediction rule.
- To compare these misclassified patients with those correctly identified as 'not at risk'.
- To identify potential improvements in pressure ulcer risk assessment.
Main Methods:
- A prospective cohort study was conducted in two Dutch hospitals from January 1999 to June 2000.
- 1229 patients admitted to various wards for over 5 days were included and examined weekly.
- Data on prognostic determinants were collected, with outcome defined as pressure ulcer grade 2 or worse.
Main Results:
- Patients who developed pressure ulcers were more likely to experience friction and shear.
- These patients also underwent surgery more frequently and for longer durations.
- Malignant conditions were a more common reason for admission among patients who developed pressure ulcers.
Conclusions:
- No specific patient characteristics clearly differentiated those with pressure ulcers misclassified as 'not at risk' from correctly classified patients.
- Improving the prediction of pressure ulcers using existing clinical information appears difficult.
- Further research may be needed to refine risk assessment tools for pressure ulcers.
Aim:
The aim of this paper is to report a study describing patients with pressure ulcers that were incorrectly classified as 'not at risk' by the prediction rule and comparing them with patients who were correctly classified as 'not at risk'.
Background:
Patients admitted to hospital are at risk of developing pressure ulcers. Although the majority of pressure ulcers can be predicted using a recently developed prediction rule, up to 30% of patients with pressure ulcers may still be misclassified.
Methods:
Between January 1999 and June 2000 a prospective cohort study was conducted in two large hospitals in the Netherlands. Patients admitted to neurology, internal, surgical, and elder care wards for more than 5 days were included (n = 1229), and were examined weekly. Information on potential prognostic determinants for pressure ulcers mentioned in the literature was recorded. Outcome was defined as occurrence of a pressure ulcer grade 2 or worse during hospital admission.
Results:
Patients who developed pressure ulcers experienced more problems with 'friction and shear' and underwent surgery more often and longer. Also, they were more often admitted because of malignant conditions.
Conclusion:
We found no specific characteristics that clearly distinguished patients with pressure ulcers that were incorrectly classified as 'not at risk' by the prediction rule from patients who were correctly classified as 'not at risk'. It appears difficult to improve further on the prediction of pressure ulcers using available clinical information.