Validität der Waterlow-Skala zur Dekubitusrisikoeinschätzung auf der Intensivstation: eine prospektive Untersuchung an 698 Patienten

Abstract

Critically ill patients are at a particular risk for developing pressure ulcers. Yet until now, no sufficiently specific, validated pressure ulcer risk assessment instruments exist for critically ill patients. In a prospective study of 698 patients of medical intensive care unit (ICU), we therefore analyzed if the Waterlow scale is suitable for pressure ulcer risk assessment in the ICU. Only patients with no pressure ulcer on admission to the ICU were included. The Waterlow scale was used to assess pressure ulcer risk on admission to the ICU, and the number of points on the scale were analyzed with regard to pressure ulcers development in the course of the ICU stay (121 patients). Our results show that adequate pressure ulcer risk assessment on admission to the ICU is not possible with the Waterlow scale. Sensitivity and specificity reached their maximal values of 64.6% and 48.8%, respectively, at a comparably high cut-off of 30 points on the Waterlow scale (positive and negative likelihood ratio being 1.26 and 0.73, respectively). The area under the curve (AUC) was 0.59 in the receiver-operator-characteristic curve. Adding intensive care related parameters to the scale yielded some degree of improvement (AUC 0.69), but the development of ICU specific pressure ulcer risk scales still seems to be necessary to allow reliable pressure ulcer risk assessment in the ICU.

Validity and reliability of the Waterlow scale for assessing pressure injury risk in critical adult patients: A multi‐centre cohort study

“…Our data revealed a cut-off score of 19, which is approximately compatible with the results of Li et al (Chunpeng, 2019) and Chen et al (Chen, 2016), varying from 20 to 22 points for the perfect balance of SEN, SPN, PPV and NPV. We also found a higher cut-off score of 30 in a study of 689 patients in the ICU (Compton et al, 2008) and 25 points in the study by Weststrate et al (1998), confirming our results. The heterogeneity in different cutoffs may be associated with the average illness severity among critical patients, more severe patients in the ICU and a higher cut-off of the TA B L E 1 Reliability and Validity of the Waterlow scale in critically adult patients (N = 5874).…”

“…Furthermore, our findings demonstrated that the Waterlow scale was overly predictive (Borghardt et al, 2015;Compton et al, 2008), with a high SEN of 62.7% and a low SPE of 57.4%. This result means that some patients receive more prophylactic treatment than they need (Wåhlin et al, 2021), which wastes medical resources.…”

Comparison of the predictive validity of the Braden and Waterlow scales in intensive care unit patients: A multicentre study

“…In addition, compared with Compton's study, our cut-off score was lower (30 vs. 23), because we included a higher proportion of male patients (61.6% vs. 56.2%) which may decreased the scores for 'sex' (Compton et al, 2008).…”

“…For example, the average age of patients (60.68 ± 15.38 years) in our study was older than in the previous study (59.4 years) (Borghardt et al., 2015), which may increase the scores for ‘age’ item. In addition, compared with Compton's study, our cut‐off score was lower (30 vs. 23), because we included a higher proportion of male patients (61.6% vs. 56.2%) which may decreased the scores for ‘sex’ (Compton et al., 2008).…”

Dekubitus

“…Ein Dekubitus der Kategorie IV (EPUAP) bleibt dies auch nach der Abheilung des Defektes (Schröder 2009). (Compton et al 2008).…”