Revalidation of a Perioperative Risk Assessment Measure for Skin

Area of Science:

• Medical Research
• Surgical Patient Care
• Wound Prevention

Background:

• Validated perioperative pressure injury (PI) risk assessment tools are scarce and often difficult to use.
• This leads to missed opportunities for targeted prevention interventions for at-risk surgical patients.

Purpose of the Study:

• To revalidate the six-item Perioperative Risk Assessment for Skin (PRAMS) measure in a larger, more generalizable sample.
• To confirm the efficacy of PRAMS in identifying patients at risk for postsurgical PIs.

Main Methods:

• Retrospective chart review of 1,526 adult surgical patients across multiple specialties.
• Evaluation of the PRAMS tool's diagnostic ability using sensitivity, specificity, and predictive values.
• Analysis of risk indicators including diabetes, age, surgical time, Braden score, previous surgery, and preexisting PI.

Main Results:

• The PRAMS tool demonstrated high effectiveness in identifying patients who developed postsurgical PIs (sensitivity = 0.98).
• Patients with PIs had lower Braden scores, preexisting PIs, and prior surgeries (p < .001).
• The tool showed a high negative predictive value (0.98), indicating patients without identified risk factors were unlikely to develop PIs.

Conclusions:

• The revalidated PRAMS tool is effective for identifying patients at risk of developing postsurgical pressure injuries.
• PRAMS utilizes readily available perioperative information, facilitating practical application by staff.
• This supports improved targeted prevention strategies for surgical patients.