背景:机械力皮肤损伤在重症监护患者中很常见,尤其是新生儿。目前,损伤的识别和严重程度评估取决于临床经验和/或严重程度工具的使用。与成年人相比,新生儿在不同的解剖位置遭受皮肤损伤,并且健康组织的层数减少(从0.9毫米减少到1.2毫米),这对直接应用依赖视觉评估的成人损伤严重程度量表产生了疑问。
目的:本范围审查(ScR)的目的是调查用于报告新生儿医院获得性皮肤损伤的严重程度量表。
方法:本研究利用2015年JoannaBriggsInstitute方法进行范围审查,并根据系统审查和Meta分析的首选报告项目进行报告,以扩展范围审查。PubMed,CINAHL,COCHRANECentral,Scopus,我们在纳入研究的参考列表中搜索了2001年至2023年期间发表的研究,其中包括在新生儿人群中使用的严重程度量表.两位作者独立确定了全面审查的研究,数据提取,和质量评估。
结果:系统的数据库搜索返回了1163条记录。在对109项研究进行全面测试后,共纳入35项研究。包括的大多数研究是在美国进行的队列或行动研究。大多数研究(57%,n=20)报告了全身获得的皮肤损伤,14(40%)的研究仅报告了鼻腔区域,一项研究报告没有解剖位置。在研究中使用了总共9种严重程度量表或量表组合(n=31),有4项研究未报告量表。来自国家压力性溃疡咨询小组的各种版本的量表(n=16),报告了欧洲压力性溃疡咨询小组(n=8)或新生儿皮肤状况评分(n=4),与当地开发的分类/量表相比(n=4)。量表主要是顺序分组(74%,n=26)或分类评估(14%,n=5)。只有2004年的一个量表对新生儿进行了验证。
结论:新生儿皮肤损伤将继续主观报告,直到一致应用严重程度量表或确定其他测量结果以支持评估。此外,无皮肤损伤评估均匀性,对皮肤护理治疗实践有效性的关键检查会有主观的比较。这篇综述表明,需要一致的皮肤评估和严重程度量表,这些量表对新生儿群体及其独特的皮肤注意事项有效。
BACKGROUND: Mechanical force skin injuries are common for critical care patients, especially neonates. Currently, identification and severity assessments of injuries are dependent on clinical experience and/or utilization of severity tools. Compared with adults, neonates sustain skin injuries in different anatomical locations and have decreased layers of healthy tissue (from 0.9 to 1.2 mm) creating questions around direct application of adult injury severity scales reliant on visual assessment.
OBJECTIVE: The aim of this scoping review (ScR) was to investigate severity scales used to report hospital acquired skin injuries for neonates.
METHODS: This study utilized the 2015 Joanna Briggs Institute methodology for scoping reviews and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews extension. PubMed, CINAHL, COCHRANE Central, Scopus, and the reference lists of included studies were searched for studies published between 2001 and 2023, that included severity scales use within neonatal population. Two authors independently identified studies for full review, data extraction, and quality assessment.
RESULTS: A systematic database search returned 1163 records. After full test review of 109 studies, 35 studies were included. A majority of studies included were cohort or action research and conducted in the United States of America. Most studies (57%, n = 20) reported skin injuries acquired throughout the body, 14 (40%) of the studies reported the nasal area alone and one study reported no anatomical location. A total of nine severity scales or combination of scales were utilized within studies (n = 31) and four studies did not report a scale. Various versions of scales from the National Pressure Ulcer Advisory Panel (n = 16), European Pressure Ulcer Advisory Panel (n = 8) or Neonatal Skin Condition Score (n = 4) were reported, compared with locally developed classifications/scales (n = 4). Scales were predominantly of ordinal grouping (74%, n = 26) or categorical assessment (14%, n = 5). Only one scale from 2004 was validated for neonates.
CONCLUSIONS: Neonatal skin injuries will continue to be reported subjectively until severity scales are consistently applied or other measurements are identified to support assessment. Additionally, without skin injury assessment uniformity, critical examination of effectiveness of skin care treatment practices will have subjective comparison. This review suggests there is a need for consistent skin assessment and severity scales that are valid for the neonatal population and their unique skin considerations.