Predictive validity of pressure ulcer risk assessment tools in intensive care patients

Abstract

Risk assessment scales are considered essential in pressure ulcer prevention. It is therefore important to use appropriate pressure ulcer risk assessment scales.The research question for this study was: what is the predictive validity of pressure ulcer risk assessment tools for intensive care patients?Design: review of the literature from 1981 to 2005 regarding the predictive validity of pressure ulcer risk assessment scales in intensive care patients.Results: only one risk scale was found for intensive care patients, namely the 'Dubbin and Jackson' scale which is a modification of the Norton scale. The method of evaluating the predictive validity of pressure ulcer risk assessment scales applied in the remainder of the scales was not suitable. In addition, none of the studies considered any factors that can affect the validity of the scale, such as the use of preventive measures or the patients' general conditions and the level of nursing care.Conclusions: There is no effective pressure ulcer risk assessment scale described in literature. When evaluating the content validity with percentage values, expert agreement is often criticised, because there is a risk of exaggerated values caused by chance agreement. More statistical methods related to validity and reliability and the choice of appropriate cut-off points of the pressure ulcer risk assessment scale have to be used to enhance the evaluation of the predictive validity of the risk scales. Pressure ulcer risk assessment scales in intensive care settings should include the general health condition, the level of nursing care and an appropriate cut-off point. It is suggested that it is required to combine risk scales and clinical judgement.