Pressure ulcers in intensive care patients may have been either over- or undertreated because a widely-used tool may not be sensitive enough for critical care, according to US researchers.
Reviewing the records of 7,790 ICU patients, researchers at the Ohio State University concluded the Braden scale was not accurate when it came to evaluating ICU patients.
“We’re beginning to identify factors unique to ICU patients”
“The scale told us that every single patient in the ICU was at high risk for a pressure ulcer. But we knew that not every single patient went on to get an ulcer,” said Brenda Vermillion, a clinical nurse specialist who participated in the study.
“Going by the score means that most ICU patients would either be under – or over treated for ulcer prevention – and neither is optimal.”
The study found a score of 16 on the Braden Scale, which is the current high risk indicator for ICU patients, would have better predictive validity and accuracy if it was moved closer to a score of 13.
However, even with shifting the risk score lower, the researchers suggest the scale still does not sufficiently reflect the characteristics of ICU patients who may have a range of comorbid conditions and medications that make them more at risk for ulcers.
Ms Vermillion added: “We’re beginning to identify factors unique to ICU patients, such as ventilator status, that can help us better predict which patients are really at risk.”
She acknowledged that Braden is still very useful in other settings and that ICU nurses will continue to use the scale as a “starting point”.
- Read the full study paper: American Journal of Critical Care (2013) 22: 514-520
What do you think?
At 1pm on Wednesday 2 April we’re going to be hosting a twitter discussion on whether there is too much reliance on assessment tools in modern healthcare.
Join in by searching for #NTtwitchat and including this hashtag in all your tweets