Development of a new risk assessment scale for predicting pressure ulcers in an intensive care unit

Abstract

AIMS AND OBJECTIVES: The study aimed to evaluate the predictive validity and accuracy of a new pressure ulcer risk assessment scale in two Indonesia intensive care units (ICUs). BACKGROUND: Several risk assessment scales have been designed to identify patients at risk of developing pressure ulcers in ICU. However, the relative weight of each variable that contributes to pressure ulcer development in these scales is not described to enable designing of a risk assessment scale. Currently, the risk factors contributing to pressure ulcer development include interface pressure, body temperature and cigarette smoking. DESIGN: A prospective cohort study was conducted in two ICUs in Pontianak, Indonesia. METHODS: A total of 253 patients were recruited to the study from both hospitals. Data collection included new risk assessment scale [i.e. the Suriadi and Sanada (S.S.) scale] scoring, demographic, pressure ulcer severity scores (based on the National Pressure Ulcer Advisory Panel) and skin condition measures. Using the S.S. scale, trained data collectors scored patients once and assessed the body temperature daily until patients were discharged. Additionally, daily data were also collected in relation to the patient's skin condition and stage of pressure ulcer. RESULTS: Out of the 253 patients, 72 (28.4%) developed pressure ulcers. In ICU A, the incidence was 27%; pressure ulcers developed into stage I (41.7%), stage II (45.8%), stage III (10.4%) and stage IV (2.1%). In ICU B, the incidence was 31.6%; the development of pressure ulcers was 48% in stage I and 52% in stage II. Using the predictive validity test, the S.S. scale balanced sensitivity (81%) and specificity (83%) at a cut-off score of 4. The area under the receiver-operating characteristic curve was 0.888 (confidence interval: 0.84-0.93). CONCLUSION: The S.S. scale was found to be a valid risk assessment tool to identify the patients at risk of developing pressure ulcers in Indonesia ICU.