Assessing the Validity and Reliability of a New Pressure Ulcer Risk Assessment Scale for Patients in Intensive Care...

The high incidence of pressure ulcers/injuries (PU/Is) among patients in intensive care units (ICUs) suggests a need for improved risk assessment.

The study aimed to develop and assess the validity and reliability of a new PU/I risk assessment scale.

The authors developed the Efteli Günes (EFGU) Pressure Ulcer Risk Assessment Scale based on a conceptual framework of risk factors developed by Coleman et al. These factors comprised direct (immobility, skin/PU status, poor perfusion) and indirect (poor sensory perception and response, diabetes, moisture, poor nutrition, low albumin) factors, as well as factors that could potentially influence risk (older age, medications, pitting edema, chronic wound infection, acute illness, increased body temperature. These factors were operationalized into 8 scale variables: skin status in areas exposed to pressure, discomfort and pain sensation in areas exposed to pressure, incontinence, diastolic blood pressure, age, diabetes, ability to make small position shifts in areas exposed to pressure, and skin tolerance test. The presence and/or extent of each factor was assigned a value; the total score ranged from 0 to 15, with higher values indicating increased risk. Intraclass correlation (ICC) was used to assess interrater agreement. To test the instrument's validity and reliability, a prospective, methodological study was conducted from September 1, 2015 to November 1, 2016, in the Neurology, Internal Medicine, Neurosurgery, Orthopedics, and Traumatology ICUs of a university hospital in Turkey. Eligible participants had to be bedbound ICU patients at least 18 years old, without a PU/I on admission, not receiving inotropic and/or vasopressor medications, and with a minimum ICU stay of 6 days. Demographic and clinical data were collected upon admission and daily thereafter until ICU discharge (maximum stay 12 weeks) or death. Descriptive statistics and Student's t and chi-squared tests were used to analyze the data. Reliability was determined using Cronbach's alpha. The Kaiser-Meyer-Olkin coefficient was used to determine validity, and the diagnostic and Youden indices were used to establish the cutoff value for risk.

Of the 207 patients included in this study 117 [56.5%] were male, mean age was 60.85 ± 16.45 years, the majority of participants (88 [42.5%]) were in the Neurology ICU), and 56 (27.1%) developed a PU/I. The presence of diabetes was found not to be a risk factor (r = 0.18), but the inability to make small position shifts (r = 0.79) was found to be a significant risk factor. After removing the diabetes variable (maximum score 14), 97.1% of patients with a score of 6 or greater on the EFGU scale score developed a PU/I. The Cronbach alpha coefficient for reliability was 0.81, sensitivity of the scale was 0.97, specificity was 0.83, positive predictive value was 0.69, and negative predictive value was 0.99. The ICC coefficient was 0.99.

The validity and reliability of the EFGU Scale seem to indicate a high predictive value for PU/I occurrence among ICU patients involved in the study. Multicenter studies involving larger samples of ICU patients are needed to validate the results.