Development and Comparison of Predictive Models for Pressure Injuries in Surgical Patients

Abstract

PURPOSE: The purpose of this study was to develop and compare 3 predictive models for pressure injury (PI) occurrence in surgical patients. DESIGN: Retrospective case-control study. SUBJECTS AND SETTING: Data on PI risk assessment and preanesthesia evaluation records from 400 patients (80 patients who developed PIs after surgery and 320 patients who did not) in a South Korean acute care setting who underwent surgery between January 2015 and May 2016 were extracted from the electronic health record. METHODS: Three models were developed with items from the Braden Scale (model 1), the Scott Triggers tool (model 2), and the Scott Triggers tool in addition to type of anesthesia, laboratory test results, and comorbid conditions (model 3) using logistic regression to analyze items (factors) in each model. Predictive performance indices, which included sensitivity, specificity, positive predictive value, negative predictive value, area under the receiver operating characteristics curve, and Akaike information criterion, were compared among the 3 models. RESULTS: Findings showed there were no significant factors in model 1, the estimated surgery time and serum albumin level were significant in model 2, and the estimated surgery time, serum albumin level, and brain disease were significant in model 3. The model performance evaluation revealed that model 2 was the best fitting model, demonstrating the highest sensitivity (84.4%), highest negative predictive value (94.6%), and lowest Akaike information criterion (302.03). CONCLUSIONS: The Scott Triggers tool in model 2, which consists of simple items that are easy to extract from preanesthesia evaluation records, was the best fitting model. We recommend the Scott Triggers tool be used to predict the development of PIs in surgical patients in acute care settings.

Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review

“…The specific factors that were found to be significant were the estimated surgery time and serum albumin level. 72 Brain disease, which was not found to be significant in the "lean" Scott-Triggers model, emerged as significant in the extended version. Another recent risk assessment tool that has demonstrated effectiveness in identifying patients who are at risk of intraoperative PUs is called the "perioperative risk assessment measure for skin" (PRAMS 74 ;).…”

“…Their logistic regression model to identify significant factors showed, as expected, that, while the Braden tool cannot identify any significant factor that predicts intraoperative PUs, the Scott‐Triggers tool (with or without the additional items) does have a predictive value. The specific factors that were found to be significant were the estimated surgery time and serum albumin level 72 . Brain disease, which was not found to be significant in the “lean” Scott‐Triggers model, emerged as significant in the extended version.…”

“…There have been additional attempts to optimise a scoring system for surgical patients, for example, Gao et al, 71 who opted to focus on application of external forces during the operation, lean body mass, duration of the operation, prone position used for surgery, cardiopulmonary bypass during surgery, and intraoperative blood loss. Another recent effort to form an improved surgical risk assessment tool was that of Park et al, 72 who used the Scott‐Triggers tool 73 as the basis for their work. The Scott‐Triggers assessment includes age, serum albumin, ASA physical status score, and the estimated surgery time 73 .…”

“…The Scott‐Triggers assessment includes age, serum albumin, ASA physical status score, and the estimated surgery time 73 . The Park 72 study enhanced this tool with several additional factors: the type of anaesthesia, laboratory test results, and comorbidity conditions. Their logistic regression model to identify significant factors showed, as expected, that, while the Braden tool cannot identify any significant factor that predicts intraoperative PUs, the Scott‐Triggers tool (with or without the additional items) does have a predictive value.…”

Defining Practices to Avoid Hospital-Acquired Pressure Injuries in the Operating Room

“…Potential validated instruments include the Braden Scale for Pressure Sore Risk (Braden Scale), Munro Scale, Scott Triggers, and the Perioperative Risk Assessment Measure for Skin (PRAMS) Scale. 14 The Braden Scale was not developed for evaluation of risk during surgical procedures and has a low predictive validity for this population. 15 However, Meehan and colleagues 16 found that a Braden Scale score of less than 16 emerged as an independent risk factor for PI development-based multiple logistic regression analysis.…”