ABSTRACT
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.
Subject(s)
Pressure Ulcer/diagnosis , Aged , Aged, 80 and over , Female , Hospitals , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Risk Assessment , SpainABSTRACT
Objetivos. Conocer la incidencia de caídas en un hospital de agudos de nivel 2. Comparar la incidencia de caídas encontrada en el estudio observacional con las caídas notificadas Método. Estudio observacional prospectivo para registrar las caídas de pacientes con seguimiento diario en las unidades de hospitalización médico quirúrgicas, y revisión del registro de notificación de caídas. El seguimiento de los pacientes se realizó entre diciembre de 2008 y marzo de 2009 en el Hospital Universitario de Fuenlabrada. Se ha calculado la incidencia acumulada de caídas, la asociación entre variables cualitativas y la validez del registro de notificación de caídas con respecto al patrón de referencia, el estudio observacional. Resultados. Se ha completado un seguimiento a 1.001 pacientes encontrando una incidencia acumulada de un 1,60% de los pacientes seguidos, frente a una incidencia notificada del 0,9%. No se han encontrado diferencias estadísticamente significativas p=0,167. El registro de notificación de caídas presenta un índice Kappa de 0,24 con una sensibilidad de 18,75% y una especificidad de 99,39% con respecto al patrón de referencia, el estudio observacional. Conclusión. La incidencia de caídas prácticamente se duplica si la recogida de datos es observacional frente a los sistemas de notificación (AU)
Aims. To determine the incidence of falls at acute hospital level and to compare this incidence with that found in the observational study with the notified falls. Method. We used a prospective observational study to register patient falls, with daily follow-up in the medical-surgical hospital units, and reviewed the notification of falls records. The patient monitoring was conducted between December 2008 and March 2009 at Fuenlabrada University Hospital. The accumulated incidence of falls was calculated, the association between qualitative variables, and the validity of the notification of falls record with regards to the reference pattern, the observational study. Results. A follow-up has been completed 1,001 patients, finding an accumulated incidence of 1.6% of the followed-up patients, compared to a notified incidence of 0.9%. No statistically significant differences were found (P=.167. The notification of falls record had a Kappa index of 0.24, with a sensitivity of 18.75% and a specificity of 99.39%, compared to the reference, the observational study. Conclusion. The incidence of falls practically doubles when using data from observational studies as opposed to those from notification systems (AU)
