Validez predictiva y fiabilidad de la escala de Braden para valoración del riesgo de úlceras por presión en una unidad de cuidados intensivos / Predictive validity and reliability of the Braden scale for risk assessment of pressure ulcers in an intensive care unit

Objetivo: Contribuir a la validación de la escala de Braden en el paciente ingresado en la UCI mediante un análisis de su fiabilidad y validez predictiva. Diseño: Analítico, observacional, longitudinal y prospectivo. Ámbito: Unidad de Cuidados Intensivos del Hospital Virgen del Rocío (Sevilla). Pacientes: Se incluyeron los pacientes de 18años o más que permanecieron ingresados en la unidad durante más de 24h. Fueron excluidos los pacientes que presentaron úlceras por presión al ingreso. En total, 335 pacientes fueron incluidos durante dos períodos de estudio de un mes de duración cada uno de ellos. Intervenciones: Ninguna. Variables de interés principales: Como variable principal se consideró la aparición de UPP en estadios delI alIV. Para el resto de variables se tomaron 3 categorías: demográficas, clínicas y de pronóstico. Resultados: La incidencia de pacientes que desarrollaron úlceras por presión fue del 8,1%. Un 40,6% han sido de estadioI y un 59,4% de estadioII, destacando el sacro como localización más frecuente. El valor del coeficiente alfa de Cronbach en las valoraciones consideradas ha indicado una fiabilidad de buena a moderada. En las 3 valoraciones realizadas un punto de corte de 12 se presentó como óptimo en la valoración del primer y segundo días de ingreso. En relación a la valoración del día con puntuación mínima, el punto de corte óptimo fue 10. Conclusiones: La escala de Braden muestra una insuficiente validez predictiva y pobre precisión tanto para un punto de corte de 18 como de 16, que son los aceptados en los distintos escenarios clínicos (AU)

Objective: Contribution to validation of the Braden scale in patients admitted to the ICU, based on an analysis of its reliability and predictive validity. Design: An analytical, observational, longitudinal prospective study was carried out. Setting: Intensive Care Unit, Hospital Virgen del Rocío, Seville (Spain). Patients: Patients aged 18years or older and admitted for over 24hours to the ICU were included. Patients with pressure ulcers upon admission were excluded. A total of 335 patients were enrolled in two study periods of one month each. Interventions: None. Variables of interest: The presence of gradeI-IV pressure ulcers was regarded as the main or dependent variable. Three categories were considered (demographic, clinical and prognostic) for the remaining variables. Results: The incidence of patients who developed pressure ulcers was 8.1%. The proportion of gradeIandII pressure ulcer was 40.6% and 59.4% respectively, highlighting the sacrum as the most frequently affected location. Cronbach's alpha coefficient in the assessments considered indicated good to moderate reliability. In the three evaluations made, a cutoff point of 12 was presented as optimal in the assessment of the first and second days of admission. In relation to the assessment of the day with minimum score, the optimal cutoff point was 10. Conclusions: The Braden scale shows insufficient predictive validity and poor precision for cutoff points of both 18 and 16, which are those accepted in the different clinical scenarios (AU)

Predictive validity and reliability of the Braden scale for risk assessment of pressure ulcers in an intensive care unit. / Validez predictiva y fiabilidad de la escala de Braden para valoración del riesgo de úlceras por presión en una unidad de cuidados intensivos.

OBJECTIVE: Contribution to validation of the Braden scale in patients admitted to the ICU, based on an analysis of its reliability and predictive validity. DESIGN: An analytical, observational, longitudinal prospective study was carried out. SETTING: Intensive Care Unit, Hospital Virgen del Rocío, Seville (Spain). PATIENTS: Patients aged 18years or older and admitted for over 24hours to the ICU were included. Patients with pressure ulcers upon admission were excluded. A total of 335 patients were enrolled in two study periods of one month each. INTERVENTIONS: None. VARIABLES OF INTEREST: The presence of gradei-iv pressure ulcers was regarded as the main or dependent variable. Three categories were considered (demographic, clinical and prognostic) for the remaining variables. RESULTS: The incidence of patients who developed pressure ulcers was 8.1%. The proportion of gradei andii pressure ulcer was 40.6% and 59.4% respectively, highlighting the sacrum as the most frequently affected location. Cronbach's alpha coefficient in the assessments considered indicated good to moderate reliability. In the three evaluations made, a cutoff point of 12 was presented as optimal in the assessment of the first and second days of admission. In relation to the assessment of the day with minimum score, the optimal cutoff point was 10. CONCLUSIONS: The Braden scale shows insufficient predictive validity and poor precision for cutoff points of both 18 and 16, which are those accepted in the different clinical scenarios.

Factores de riesgo asociados al desarrollo de úlceras por presión en unidades de cuidados intensivos de adultos: revisión sistemática / Risk factors for pressure ulcer development in intensive care units: A systematic review

Introducción: Las úlceras por presión representan un significativo problema para pacientes, profesionales y sistemas sanitarios. Presentan una incidencia y una prevalencia importantes a nivel mundial. Su carácter iatrogénico plantea que su aparición es evitable y su incidencia es un indicador de calidad científico-técnica tanto en el ámbito de la atención primaria como en el de la especializada. El objetivo de esta revisión ha sido identificar los factores de riesgo relacionados con la aparición de úlceras por presión en pacientes críticos. Metodología: Se siguieron las recomendaciones de la declaración PRISMA adaptadas a la identificación de estudios sobre factores de riesgo. Se ha realizado una revisión sistemática cualitativa de estudios primarios a través de una búsqueda en Pubmed, The Cochrane Library, Scopus y Web of Science. Se consideraron las limitaciones metodológicas en estudios observacionales. Resultados: De 200 referencias bibliográficas, 17 cumplieron nuestros criterios de selección. Estos estudios incluyeron 19.363 pacientes ingresados en unidades de cuidados intensivos. Seis se clasificaron como de calidad fuerte y 11 de calidad moderada. Los factores de riesgo que aparecieron más frecuentemente asociados al desarrollo de úlceras por presión incluyeron: edad, tiempo de estancia en UCI, diabetes, tiempo de PAM <60-70mmHg, ventilación mecánica, duración de la ventilación mecánica, terapia de hemofiltración venovenosa continua o diálisis intermitente, tratamiento con drogas vasoactivas, con sedantes y cambios posturales. Conclusiones: No aparecen factores de riesgo que por sí mismos puedan predecir la aparición de la úlcera por presión. Más bien se trata de una interrelación de factores que incrementan la probabilidad de su desarrollo (AU)

Introduction: Pressure ulcers represent a significant problem for patients, professionals and health systems. Their reported incidence and prevalence are significant worldwide. Their character iatrogenic states that its appearance is preventable and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. The aim of this review was to identify risk factors associated with the occurrence of pressure ulcers in critically ill patients. Methodology: The PRISMA Declaration recommendations have been followed and adapted to studies identifying risk factors. A qualitative systematic review of primary studies has been performed and a search was conducted of the PubMed, The Cochrane Library, Scopus and Web of Science databases. Methodological limitations in observational studies have been considered. Results: From 200 references, 17 fulfilled the eligibility criteria. These studies included 19,363 patients admitted to intensive care units. Six studies were classified as high quality and 11 were classified as moderate quality. Risk factors that emerged as predictive of pressure ulcers development more frequently included age, length of ICU stay, diabetes, time of MAP <60-70mmHg, mechanical ventilation, length of mechanical ventilation, intermittent haemodialysis or continuous veno-venous haemofiltration therapy, vasopressor support, sedation and turning. Conclusions: There is no single factors which can explain the occurrence of pressure ulcers. Rather, it is an interplay of factors that increase the probability of its development (AU)

[Adaptation and validation of five scales to measure determinants of binge drinking in adolescents]. / Adaptación y validación al español de cinco escalas para evaluar los determinantes del consumo de alcohol en adolescentes.

BACKGROUND: The aim of this study was to validate five scales, based on a theoretical framework for the adoption of behaviours, designed to assess the determinants in binge drinking in adolescents, namely: attitude, social influence (model, norm and pressure) and self-efficacy. METHODS: Observational, cross-sectional and multicentre study. Through convenience sampling, 397 adolescents between 15 to 18 years old enrolled in secondary schools in Seville and Huelva were included. After translation and review of the original instrument by a panel of experts, a questionnaire was obtained in Spanish that was administered to a pilot sample to assess comprehensibility and, subsequently, the participants completed the five scales to check the structural validity (factor analysis and reliability) and construct validity. RESULTS: On the five scales, the first factor explained at least 28% of the variance and the total variance explained was always greater than 60%. After rotation, all items had weights >0.40 for the factor to which they belonged. Cronbach´s alpha ranged from 0.62 to 0.91. Spearman's coefficient was lower than 0.7 when correlating the sub-dimensions of the scales, except on the self-efficacy scale, assuming multidimensionality with certain limitations. CONCLUSIONS: Five scales are presented with indications of reliability and validity, their items reflect the theoretical frame of reference and can evaluate the determinants of binge drinking. In the future, validation could be continued to determine its reproducibility, its criterion validity with a "gold standard" or objective measure. Key words. Adolescents. Health behaviour. Binge drinking. RISK FACTORS: Validation studies.

Adaptación y validación al español de cinco escalas para evaluar los determinantes del consumo de alcohol en adolescentes / Adaptation and validation of five scales to measure determinants of binge drinking in adolescents

Fundamento: Validar cinco escalas, basadas en un marco teórico para la adopción de comportamientos, que fueron diseñadas para evaluar los factores implicados en el consumo episódico excesivo de alcohol (CEEA) en adolescentes, concretamente: actitud, influencia social (Modelo, Norma y Presión) y autoeficacia. Material y métodos: Estudio observacional, transversal y multicéntrico. Mediante muestreo por conveniencia se incluyeron 397 adolescentes de 15 a 18 años escolarizados en institutos de Educación Secundaria de Sevilla y Huelva. Tras la traducción y revisión del instrumento por un panel de expertos se obtuvo un cuestionario en español que fue administrado a una muestra piloto para valorar la comprensibilidad y, posteriormente, los participantes completaron las cinco escalas para comprobar la validez estructural (análisis factorial y fiabilidad) y la validez de constructo. Resultados: En las cinco escalas, el primer factor explicó al menos el 28% de la varianza y la varianza total explicada fue siempre mayor que 60%. Tras la rotación, las cargas factoriales de los ítems fueron mayores a 0,40 para su factor de pertenencia. El alfa de Cronbach osciló desde 0,62 hasta 0,91. El coeficiente de Spearman fue menor a 0,7 al correlacionar las subdimensiones de las escalas, salvo en la escala de Autoeficacia, asumiendo multidimensionalidad con ciertas limitaciones. Conclusiones: Se presentan cinco escalas con indicios de fiabilidad y validez, cuyos ítems reflejan el marco teórico de referencia y que pueden evaluar los determinantes del CEEA. En el futuro se debería continuar con la validación para determinar su reproducibilidad, su validez de criterio con un 'gold estándar' o medida objetiva (AU)

Background: The aim of this study was to validate five scales, based on a theoretical framework for the adoption of behaviours, designed to assess the determinants in binge drinking in adolescents, namely: attitude, social influence (model, norm and pressure) and self-efficacy. Methods: Observational, cross-sectional and multicentre study. Through convenience sampling, 397 adolescents between 15 to 18 years old enrolled in secondary schools in Seville and Huelva were included. After translation and review of the original instrument by a panel of experts, a questionnaire was obtained in Spanish that was administered to a pilot sample to assess comprehensibility and, subsequently, the participants completed the five scales to check the structural validity (factor analysis and reliability) and construct validity. Results: On the five scales, the first factor explained at least 28% of the variance and the total variance explained was always greater than 60%. After rotation, all items had weights >0.40 for the factor to which they belonged. Cronbach's alpha ranged from 0.62 to 0.91. Spearman's coefficient was lower than 0.7 when correlating the sub-dimensions of the scales, except on the self-efficacy scale, assuming multidimensionality with certain limitations. Conclusions: Five scales are presented with indications of reliability and validity, their items reflect the theoretical frame of reference and can evaluate the determinants of binge drinking. In the future, validation could be continued to determine its reproducibility, its criterion validity with a 'gold standard' or objective measure (AU)

Risk factors for pressure ulcer development in Intensive Care Units: A systematic review. / Factores de riesgo asociados al desarrollo de úlceras por presión en unidades de cuidados intensivos de adultos: revisión sistemática.

INTRODUCTION: Pressure ulcers represent a significant problem for patients, professionals and health systems. Their reported incidence and prevalence are significant worldwide. Their character iatrogenic states that its appearance is preventable and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. The aim of this review was to identify risk factors associated with the occurrence of pressure ulcers in critically ill patients. METHODOLOGY: The PRISMA Declaration recommendations have been followed and adapted to studies identifying risk factors. A qualitative systematic review of primary studies has been performed and a search was conducted of the PubMed, The Cochrane Library, Scopus and Web of Science databases. Methodological limitations in observational studies have been considered. RESULTS: From 200 references, 17 fulfilled the eligibility criteria. These studies included 19,363 patients admitted to intensive care units. Six studies were classified as high quality and 11 were classified as moderate quality. Risk factors that emerged as predictive of pressure ulcers development more frequently included age, length of ICU stay, diabetes, time of MAP <60-70mmHg, mechanical ventilation, length of mechanical ventilation, intermittent haemodialysis or continuous veno-venous haemofiltration therapy, vasopressor support, sedation and turning. CONCLUSIONS: There is no single factors which can explain the occurrence of pressure ulcers. Rather, it is an interplay of factors that increase the probability of its development.

Factores de riesgo asociados al desarrollo de úlceras por presión en unidades de cuidados intensivos de adultos: revisión sistemática / Risk factors associated with the development of pressure ulcers in intensive care units of adults: systematic review

Introducción Las úlceras porpresión representan un significativo problema para pacientes, profesionales y sistemas sanitarios. Presentan una incidencia y una prevalencia importantes a nivel mundial. Su carácter iatrogénico plantea que su aparición es evitable y su incidencia es un indicador de calidad científico-técnica tanto en el ámbito de la atención primaria como en el de la especializada. El objetivo de esta revisión ha sido identificar los factores de riesgo relacionados con la aparición de úlceras por presión en pacientes críticos. Metodología Se siguieron las recomendaciones de la declaración PRISMA adaptadas a la identificación de estudios sobre factores de riesgo. Se ha realizado una revisión sistemática cualitativa de estudios primarios a través de una búsqueda en Pubmed, The Cochrane Library, Scopus y Web of Science. Se consideraron las limitaciones metodológicas en estudios observacionales. Resultados De 200 referencias bibliográficas, 17 cumplieron nuestros criterios de selección. Estos estudios incluyeron 19.363 pacientes ingresados en unidades de cuidados intensivos. Seis se clasificaron como de calidad fuerte y 11 de calidad moderada. Los factores de riesgo que aparecieron más frecuentemente asociados al desarrollo de úlceras por presión incluyeron: edad, tiempo de estancia en UCI, diabetes, tiempo de PAM <60-70mmHg, ventilación mecánica, duración de la ventilación mecánica, terapia de hemofiltración venovenosa continua o diálisis intermitente, tratamiento con drogas vasoactivas, con sedantes y cambios posturales. Conclusiones No aparecen factores de riesgo que por sí mismos puedan predecir la aparición de la úlcera por presión. Más bien se trata de una interrelación de factores que incrementan la probabilidad de su desarrollo.

[Design and validation of scales to measure adolescent attitudes toward sexuality, addictive substances and road safety. Are they related to behaviour?]. / Diseño y validación de escalas para medir la actitud adolescente hacia: sexualidad, sustancias adictivas y seguridad vial ¿se relacionan con los comportamientos?

BACKGROUND: To validate scales to measure adolescent attitudes toward sexuality (EAS), toward addictive substances (EASA) and toward vial security (EASV), and to examine their correlations with behaviour on these areas. METHODS: We designed the scales by literature review; we validated their content using a Delphi-on-line panel with 18 experts, and a pre-test with a sample of 21 fourth-grade high-school students (similar to 10th in US) in Seville, Spain. The scales were administered to 188 fourth-grade high-school students in order to test their construct validity (exploratory factor analysis), their reliability (Alpha Cronbach test), and to determinate their correlations with age, gender, experience of sexual intercourse, substance use and road behaviour. RESULTS: EAS-10 obtained α=0.73, EASA-12 obtained α=0.80, EASV-12 obtained α=0.79. They showed evidence of one-dimensional interpretation after factor analysis, a) all items achieved weights r>0.30 in the first factor, which explained a significant proportion of variance before rotations, and b) total variance explained by the main factors extracted was greater than 50%. We found correlations between EASA-12 and tobacco use (r=-0.43, p<0.001), alcohol use (r=-0.30, p<0.001), age of alcohol initiation (r=0.32, p=0.003), and substance use (r=-0.55, p<0.001), and between EASV-12 and safe road behaviour (r=0.41, p<0.001), tobacco use (r=-0.23, p=0.003), alcohol use (r=-0,22, p=0,003), age of first experience of drunkenness (r=0.22, p=0.003), and substance use (r=-0.27, p=0.013). CONCLUSIONS: The scales showed their reliability and validity. They could be employed for assessing adolescent attitudes to these priority intervention areas, for carrying out studies on their mediating role on adopting behaviour, and for designing and evaluating health programs.

Diseño y validación de escalas para medir la actitud adolescente hacia: sexualidad, sustancias adictivas y seguridad vial. ¿Se relacionan con los comportamientos? / Design and validation of scales to measure adolescent attitudes toward sexuality, addictive substances and road safety. Are they related to behaviour?

Fundamento. Validar escalas para evaluar la actitud adolescente hacia la sexualidad (EAS), las sustancias adictivas (EASA) y la seguridad vial (EASV), y examinar sus relaciones con comportamientos en dichas áreas. Material y métodos. Se diseñaron las escalas mediante revisión bibliográfica, se valido su contenido mediante panel Delphi on-line con 18 expertos y pretest con 21 alumnos de cuarto de educación secundaria obligatoria en Sevilla. Estas se administraron junto a preguntas sobre comportamientos a otros 188 alumnos para determinar su validez de constructo (análisis factorial exploratorio), fiabilidad (Alfa de Cronbach) y su correlación con las variables: edad, genero, inicio de relaciones sexuales, consumo de sustancias y practicas viales. Resultados. La escala EAS-10 obtuvo un alfa=0,73, EASA-12 de alfa=0,80, y EASV-12 de alfa=0,79. Mostraron evidencias de unidimensionalidad en el análisis factorial, a) pesos r>0,30 en el primer factor, que explicaba una proporción importante de varianza, b) varianza total explicada por factores principales mayor al 50%. Se encontraron correlaciones entreEASA-12 y experimentación con tabaco (r=-0,43, p<0,001) y alcohol (r=-0,30, p<0,001), edad de inicio al alcohol (r=0,32,p=0,003), edad de la primera borrachera (r=0,31, p=0,003), y consumo de sustancias (r=-0,55, p<0,001), y entre EASV-12 y practicas viales seguras (r=0,41, p<0,001), experimentación con tabaco (r=-0,23, p=0,003) y alcohol (r=-0,22, p=0,003),edad de la primera borrachera (r=0,22, p=0,003), y consumo de sustancias (r=-0,27, p=0,014). Conclusiones. Las escalas demostraron validez y fiabilidad. Pueden ser utilizadas para valorar la actitud de adolescentes españoles hacia estas áreas, determinar su papel mediador en la adopción de comportamientos y diseñar y evaluar programas de salud (AU)

Background. To validate scales to measure adolescent attitudes toward sexuality (EAS), toward addictive substances (EASA) and toward vial security (EASV), and to examine their correlations with behaviour on these areas. Methods. We designed the scales by literature review; we validated their content using a Delphi-on-line panel with18 experts, and a pre-test with a sample of 21 fourth-grade high-school students (similar to 10th in US) in Seville, Spain. The scales were administered to 188 fourth-grade high school students in order to test their construct validity (exploratory factor analysis), their reliability (Alpha Cronbach test), and to determinate their correlations with age, gender, experience of sexual intercourse, substance use and road behaviour. Results. EAS-10 obtained alpha=0.73, EASA-12 obtained alpha=0.80,EASV-12 obtained alpha=0.79. They showed evidence of one dimensional interpretation after factor analysis, a) all items achieved weights r>0.30 in the first factor, which explained a significant proportion of variance before rotations, and b) total variance explained by the main factors extracted was greater than 50%. We found correlations between EASA-12 and tobacco use (r=-0.43, p<0.001), alcohol use (r=-0.30, p<0.001), age of alcohol initiation (r=0.32, p=0.003), and substance use (r=-0.55, p<0.001), and between EASV-12 and safe road behaviour (r=0.41, p<0.001), tobacco use (r=-0.23,p=0.003), alcohol use (r=-0,22, p=0,003), age of first experience of drunkenness (r=0.22, p=0.003), and substance use (r=-0.27, p=0.013).Conclusions. The scales showed their reliability and validity. They could be employed for assessing adolescent attitudes to these priority intervention areas, for carrying out studies on their mediating role on adopting behaviour, and for designing and evaluating health programs (AU)