■最近,关于标准压疮(PU)风险评估工具的有效性,越来越多的不确定性出现了,怀疑不比临床判断好,尤其是在体弱多病的老年人群中。本研究旨在确定住院老年人PU发展和严重程度的主要临床预测变量,利用多维脆弱评估,并将它们与Braden量表进行比较。
■人群由316名患者组成,21/02/22-01/07/22期间,在(意大利)Sarzana的SanBartolomeo医院接受老年科和过渡护理。收集的信息包括记忆和实验室数据。进行了全面的老年评估,还包括人体测量和物理性能测量。采用多因素logistic分析,在二元分类测试和随后的严重程度顺序分类测试中。通过ROC曲线估计和与Braden量表的AUC比较来评估模型的最终性能。
■在人口中,152名受试者(48%)在不同严重程度发展PU。结果表明,年龄,Braden量表(流动性和摩擦/剪切子量表),Barthel秤,迷你营养评估,血红蛋白,和白蛋白是与PU发展相关的预测因子(AUC85%)。结果是优于单独使用Braden量表(AUC75%)。关于PU严重程度的预测因素的识别,4AT也成为潜在相关的。
■评估受试者的营养状况,物理性能,和功能自主性使Braden量表能够有效整合,以识别最易患PU的患者。我们的发现支持将一套全面的方法论上稳健的脆弱决定因素整合到传统的风险评估工具中。这种整合反映了患者虚弱之间的相互作用,皮肤脆弱,和PU的发展在非常老的住院患者。
UNASSIGNED: In recent times, growing uncertainty has emerged regarding the effectiveness of standard pressure ulcer (PU) risk assessment tools, which are suspected to be no better than clinical judgment, especially in the frail and comorbid elderly population. This study aimed to identify the primary clinical predictive variables for PU development and severity in hospitalized older adults, utilizing a multidimensional frailty assessment, and compare them with the Braden scale.
UNASSIGNED: The population consisted of 316 patients, admitted to the Geriatric Unit and Transitional Care of San Bartolomeo Hospital in Sarzana (Italy) during the period 21/02/22-01/07/22. The collected information included both anamnestic and laboratory data. A comprehensive geriatric assessment was performed, including also anthropometric and physical performance measurements. Multivariate logistic analysis was used, both in a binary classification test and in the subsequent ordinal classification test of severity levels. The final performance of the model was assessed by ROC curve estimation and AUC comparison with the Braden scale.
UNASSIGNED: Within the population, 152 subjects (48%) developed PU at different levels of severity. The results showed that age, Braden scale (subscales of mobility and friction/shear), Barthel scale, Mini Nutritional Assessment, hemoglobin, and albumin are predictors associated with the development of PU (AUC 85%). The result is an improvement over the use of the Braden scale alone (AUC 75%). Regarding the identification of predictive factors for PU severity, 4AT also emerges as potentially relevant.
UNASSIGNED: Assessing the subject\'s nutritional status, physical performance, and functional autonomies enables the effective integration of the Braden scale in identifying patients most susceptible to developing PU. Our findings support the integration of a comprehensive set of methodologically robust frailty determinants into traditional risk assessment tools. This integration reflects the mutual interplay between patients\' frailty, skin frailty, and PU development in very old hospitalized patients.