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The braden scale cannot be used alone for assessing pressure ulcer risk in surgical patients: a meta-analysis.
MedLine Citation:
PMID:  22316631     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
The validity and reliability of the Braden Scale for pressure ulcer development has been established in a variety of patient care settings, but studies suggest the scale does not capture risk factors in surgical patients. The purpose of this metaanalysis was to assess the predictive validity of the Braden Scale for pressure ulcer development in surgical patients. A literature search using PubMed and Web of Science databases (through July 2011) was conducted to identify all clinical studies on predicting pressure ulcers in surgical patients using the Braden Scale. To be eligible for inclusion, studies had to include sensitivity (true positive rate, TPR) and specificity (true negative rate, TNR) results or include sufficient data to calculate these factors. Study quality was assessed using the 14-item Quality Assessment of Diagnostic Accuracy Studies (QUADAS) instrument, and two-by-two tables of predictive validity were constructed from each article. Meta-analysis for predictive validity was performed, including calculation of pooled sensitivity, pooled specificity, diagnostic odds ratio (DOR), construction of summary receiver operating characteristic (SROC) curves, and overall diagnostic accuracy (Q*). Three studies (N = 609 patients) met the meta-analysis inclusion criteria. The pooled estimates for sensitivity and specificity were 0.42 (95% CI: 0.38 to 0.47) and 0.84 (95% CI: 0. 83 to 0.85), respectively, yielding a combined DOR of 4.40 (95% CI: 2.98 to 6.50). The area under the ROC curve (AUC) was 0.6921 ± 0.0346, and the Q* was 0.6466 ± 0.0274. Significant heterogeneity was noted between the included studies with Q value 34.49 (P = 0.0321), and I2 for pooled sensitivity, pooled specificity, and pooled DOR was 88.7%, 98.6%, and 39.1%, respectively. Although the observed heterogeneity between studies may have affected the results, the low values for overall diagnostic accuracy (Q*) and diagnostic capability (AUC) indicate the Braden Scale has low predictive validity for pressure ulcer risk in surgical patients. A new pressure ulcer risk assessment scale for surgical patients should be developed and tested.
Authors:
Hong-Lin Chen; Peng Liu; Wei He
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Ostomy/wound management     Volume:  58     ISSN:  1943-2720     ISO Abbreviation:  Ostomy Wound Manage     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-09     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8912029     Medline TA:  Ostomy Wound Manage     Country:  United States    
Other Details:
Languages:  eng     Pagination:  34-40     Citation Subset:  N    
Affiliation:
School of Nursing, Nantong University, Nantong, Jiangsu PR China; email: pphss@126.com.
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