Validity of the current risk assessment scale for pressure ulcers in intensive care (EVARUCI) and the Norton-MI scale in critically ill patients.

OBJECTIVE: The objective of this study was to evaluate the validity of risk detection scales EVARUCI and Norton-MI (modified by INSALUD) to detect critical adult patients with the risk of developing pressure ulcers (PU) in an intensive care unit (ICU). DESIGN: The authors have conducted a descriptive, prospective study at the ICU in their hospital from 2008 to 2014. The evaluations of both scales were registered daily by nurses from the unit. PATIENTS: Adult patients admitted into the ICU. MAIN OUTCOMES MEASURE: The study measured the sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of each of the scores for both scales and areas under curve (AUC) of receiver operating characteristics (ROC). MAIN RESULTS: The authors have evaluated a total of 2534 patients. For the cut-off point recommended by the authors in the scale Norton-MI (PC 14), a sensitivity of 94,05% (93,28-94,82) was obtained, specificity of 40,47% (39,72-41,22), VPP 26,22% and VPN 96,80%. For EVARUCI (CP 10) a sensitivity of 80,43% (79,15-81,72), specificity 64,41 (63,68-65,14), VPP 33,71% and VPN of 93,60%. The ABC-COR was 0,774 with a 95% CI of 0,766 to 0,781 for the scale of Norton-MI and 0.756 with a 95% CI of 0,749 to 0,764 for EVARUCI. CONCLUSION: Both scales are valid to help predict the risk of developing PU in critical patients. The sensitivity and ABC-COR are very similar for EVARUCI and Norton-Mi. The authors state they do not have any financial interests linked to this article.

Braden Scale and Norton Scale modified by INSALUD in an acute care hospital: validity and cutoff point.

OBJECTIVE: The objective of this article was to determine the most suitable cutoff point (CP) for the Braden Scale and Norton Modified Scale by INSALUD Scale (Norton-MI) in an acute care hospital. DESIGN: The authors have designed a prospective, descriptive study of patients from their hospital. From December 2008 to March 2009, a nurse collected and recorded adult patient data daily, including the appearance of pressure ulcers. PATIENTS: Adult patients in medical and surgical wards. MAIN OUTCOMES MEASURE: The parameters used in both scales are sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under curve (AUC) of receiver operating characteristic (ROC). MAIN RESULTS: In the end, the authors have evaluated a total of 1001 patients and obtained 4486 measurements with both the Norton-MI and the Braden scales. The rates for the recommended CP of the Norton-MI scale (CP 14) are as follows: sensitivity: 67.91% (62.42-73.39), specificity: 78.66% (77.41-79.92), PPV: 18.36%, NPV: 97.20%. Those for Braden (CP 16) are as follows: sensitivity: 65.69% (64.19-75), specificity: 79.62% (78.39-80.85), PPV: 19.43%, NPV: 97.37%. The Norton-MI scale offers an AUC-ROC of 0.828 with a 95% confidence interval of 0.811-0.854, and the Braden Scale presents an AUC-ROC of 0.832 with a 95% confidence interval of 0.807 to 0.849. CONCLUSION: Both scales show good validity data. If the CP is raised: MI-Norton (CP 15): sensitivity: 77.36 (72.43-82.30), specificity 74.27 (72.94-75.61), PPV: 17.52 (15.42-19.62), NPV: 97.89 (97.38-98.41). The Braden scale with a CP of 17 presents sensitivity: 78.38 (73.52-83.24), specificity: 73.44 (72.09-74.79), PPV: 17.25 (15.19-19.31), NPV: 97.96 (97.45-98.47). These CPs improved the predictive capacity of both scales in the authors' hospital environment.