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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Predictive validity of a pressure injury risk assessment tool at different time-points in patients admitted to the
Angel Cobos-Vargas1, Maria Acosta-Romero1, Luis Camado-Sojo1
1Critical Care Department, Hospital Universitario Clínico San Cecilio, Granada, Spain.
Insights
The COMHON index effectively predicts pressure injuries (PIs) in intensive care unit (ICU) patients, with mean and highest scores showing the best predictive capacity. Sequential risk assessment during ICU stays improves accuracy for timely preventive measures.
Area of Science:
- Critical Care Medicine
- Nursing Research
- Patient Safety
Background:
- Pressure injuries (PIs) are a significant concern for intensive care unit (ICU) patients.
- Existing risk assessment tools are often validated only at admission, potentially missing evolving risks.
- Dynamic risk assessment during ICU stay is crucial for accurate prediction and prevention of PIs.
Purpose of the Study:
- To evaluate the predictive validity of the conscious level, mobility, haemodynamic, oxygenation and nutrition (COMHON) index for PIs in ICU patients.
- To assess the COMHON index's predictive performance at multiple time points during the ICU stay.
- To determine the optimal time point for risk assessment using the COMHON index.
Main Methods:
- An observational prospective study was conducted over one year with patients admitted to the ICU for more than three days.
- COMHON scores were calculated at admission, 72 hours, and as highest and mean scores during the ICU stay.
- Predictive validity was assessed using accuracy parameters and receiver operating characteristic curves (AUC), with a cutoff point determined.
Main Results:
- The study included 286 patients, with a PI incidence of 15.4%.
- The COMHON index demonstrated strong predictive validity, with AUCs ranging from 0.749 to 0.907.
- The mean and highest COMHON scores showed the best predictive capacity, outperforming admission scores.
Conclusions:
- The COMHON index is a valid tool for predicting PIs in ICU patients.
- Sequential risk assessment, particularly using mean and highest scores, is more accurate than admission-only assessment.
- Higher COMHON scores significantly correlate with increased risk of developing PIs, necessitating tailored preventive strategies.
Background:
Multiple risk assessment scales are available for predicting the development of pressure injuries (PIs) in patients in the intensive care unit (ICU). Most PI risk assessment tools have been validated at the time of admission; however, another time point during treatment could better reflect clinical changes and therefore, the risk of PIs.
Aim:
The study aimed to examine the predictive validity of PI risk assessment scale designed for ICU patients, the conscious level, mobility, haemodynamic, oxygenation and nutrition (COMHON) index, at several time points or intervals during ICU stay.
Study Design:
This was an observational prospective study undertaken over a period of 1 year (July 2021-June 2022). Patients admitted to ICU for >3 days were included. The number, location and degree of the PIs were recorded. The level of risk for developing PIs during the stay was determined by calculating the COMHON scores at admission, and 72 h, as well as the highest and mean score. Predictive validity was studied using accuracy parameters and areas under the receiver operating characteristic curve (AUC). The best cutoff point was also determined and used to compare risk between categories.
Results:
Of the 286 patients included in the study, 160 (59%) were male. The level of severity evaluated using the APACHE II scale was 18.4 ± 5.8 points. Invasive mechanical ventilation was used in 32.1% (n = 92) of the patients and 20.6% (n = 59) received high flow oxygen therapy. The incidence of PI was 15.4% (n = 44), with sacral location in 47.7% (n = 21) and grade II in 75% (n = 33) of the patients. The AUC was 0.907 (0.872-0.942); 0.881 (0.842-0.920); 0.877 (0.835-0.920) and 0.749 (0.667-0.831) at the mean, the highest, 72 h and ICU admission scores, respectively. The best cutoff point was 13 in all patients. The risk of developing a PI was 6.4 times higher in the high-risk group (>13 points).
Conclusions:
The best predictive capacity for the COMHON index risk assessment was the mean and highest scores. The predictive accuracy was higher on the third day of the patient's stay than on admission, and this was attributed to the clinical changes observed in some patients over the course of their critical illness.
Relevance For Clinical Practice:
Patients in ICU are at high risk of developing PIs, therefore, preventive measures should be maximized. Risk assessment should be carried out sequentially owing to the changes that patients present throughout their ICU stay and preventive measures should be used according to the risk level.
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