Discriminatory ability of the current pressure ulcer risk assessment scale in critically ill patients in Quito, Ecuador

Abstract

Introduction

Pressure ulcers are adverse events that increase morbidity, mortality and costs. Critically ill patients have several risk factors. There are scales that predict their occurrence; however, it is necessary to use specific scales in critically ill patients.

Objective

To evaluate the discriminative ability of the current pressure ulcer risk assessment scale in critically ill patients in Quito, Ecuador.

Method

Observational, longitudinal, prospective study. Patients hospitalized for more than 48 h without evidence of ulcers on admission were recruited. Demographic and clinical variables were recorded, as well as the current risk assessment scales, Norton, and the appearance of ulcers on a daily basis. Data were analyzed using the JAMOVI statistical package version 2.4. The significance level was P < .05.

Results

A total of 306 patients were enrolled, 5 developed ulcers, an incidence of 1.63%. Grade 2 ulcers and sites on the face and head were most common. For the current risk assessment scale, the ROC curve defined the best cut-off point of 13, at 48 h, Youden index 0.678, sensitivity 100%, specificity 67.77%, positive predictive value 4.9%, negative predictive value 100%, with an AUC of 0.855, with a relative risk of 1.05, with 95% confidence intervals of 1.01–1.10. For Norton, the ROC curve defined the best cut-off point as 9, at 48 h, Youden index 0.646, sensitivity 64.65%, specificity 100%, positive predictive value 100%, negative predictive value 4.55%, AUC 0.874, with a relative risk of 1.04, with 95% confidence intervals of 1.01–1.08.

Conclusions

The current risk assessment scale, similar to the Norton scale, can be used to discriminate the occurrence of pressure ulcers in critically ill patients. The best assessment may be at 48 h after admission, with a cut-off point of 13.