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Redetermining the cutoff point of peristomal infection scoring: Methodological research
Hatice Ayhan1, Kezban Akcay2, Yeter Nilgun Olmez2
1Department of Surgical Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey.
Insights
A new scoring system effectively identifies peristomal infections in patients receiving enteral nutrition. The Peristomal Infection Scoring System, with a cutoff of 6 points, is a reliable diagnostic tool for healthcare professionals.
Area of Science:
- Medical Research
- Clinical Diagnostics
- Nutrition Support
Background:
- Peristomal infections are common complications in patients with enteral nutrition.
- Current diagnostic methods lack standardized, validated tools.
- A reliable scoring system is needed for timely diagnosis and treatment.
Purpose of the Study:
- To evaluate the validity and reliability of the Peristomal Infection Scoring System (PISS).
- To determine the optimal cutoff value for diagnosing peristomal infections using PISS.
- To establish PISS as a dependable clinical tool.
Main Methods:
- Methodological research involving 54 adult participants.
- Independent evaluation of peristomal areas by two nutrition nurses and one physician.
- Assessment using PISS, local signs/symptoms, receiver operating characteristic (ROC) curve, and interobserver reliability.
Main Results:
- The Peristomal Infection Scoring System demonstrated high diagnostic accuracy (98.1%) with a cutoff of 6 points.
- Excellent interobserver agreement (κ = 1.000) was achieved.
- The ROC curve analysis showed strong performance (area under curve = 0.98).
Conclusions:
- The Peristomal Infection Scoring System, with a cutoff value of 6, is a valid and reliable instrument for diagnosing peristomal infections.
- This scoring system is practical for use by healthcare professionals in various clinical settings.
- Early and accurate diagnosis of peristomal infections can be facilitated by this tool.
Background:
Peristomal infections are a frequently encountered problem in enteral nutrition that warrants prompt diagnosis and early antimicrobial treatment. Current practice lacks a consensus on an accepted measurement tool with acknowledged validity and reliability. The Peristomal Infection Scoring System is one such tool that shows promise, yet the optimal cutoff value remains to be determined.
Methods:
This methodological research was conducted with 54 adult participants to evaluate their peristomal areas in terms of infection by two nurse nutritionists and an expert physician in a simultaneous and independent manner, using peristomal infection scoring or the local signs and symptoms of infection. Performance was assessed by the receiver operating characteristic curve, interobserver reliability, and validity metrics.
Results:
According to the expert physician's opinion, the peristomal infection rate was 9.2%. The agreement between the observers using the Peristomal Infection Scoring System was κ = 1,000, P < .001. The peristomal infection scoring area under the receiver operating characteristic curve was 0.98 (P < .001), and the best cutoff value was found to be 6 points, which correlated positively with a 0.88 coefficient (P < .001) and an accuracy of 98.1% (CI, 90.11%-99.95%).
Conclusion:
The Peristomal Infection Scoring System with a cutoff value of 6 points is a valid and reliable instrument to diagnose peristomal infections. It can be easily used by healthcare professionals in all settings as needed.
