Moving average as a method of assessing risk of pressure injury using the COMHON index (Conscious level, Mobility, Hemodynamic, Oxygenation, Nutrition) for patients in intensive care units.

BACKGROUND: Moving average is the continuously updated arithmetic mean of the pressure injury (PI) risk score values measured with the COMHON Index (Conscious level, Mobility, Hemodynamics, Oxygenation, Nutrition). OBJECTIVE: The objective of this study was to validate the moving average as a method to measure the level of risk of PI. METHOD: This is a cohort study of adult patients admitted for a duration of more than 24 h in an intensive care unit (ICU) of a tertiary-level university hospital, between June 1, 2018, and December 31, 2019. The risk of PI was obtained with the COMHON Index, and its 3-day moving average was used to monitor the risk of PI. To assess the predictive ability of the moving average score, a receiver operating characteristic curve analysis was performed, obtaining the area under the curve, and the Youden Index to determine the optimal cut-off point of the PI risk moving average score using the COMHON Index. RESULTS: A total of 1335 patients (94.6% of admissions) were included, and 82 developed PI (cumulative incidence of 6.1%) in the 18 months of the study. The highest incidence of PI was in the sacrum (49%) followed by the heel (17.6%). The median age was 65 (54-73) years, and the median length of stay was 3.8 (1.9-9) days. The moving average score had an area under the receiver operating characteristic curve of 87% (95% confidence interval: 85%-89%), with a cut-off point of the moving average score ≥11, and the negative predictive value was 99.6%. CONCLUSIONS: The moving average score combined with a validated scale is a useful method to predict potential PI of patients admitted to the ICU. Its use is suggested for decision-making during the implementation of the care plan related to the prevention of PI in patients admitted to the ICU.

Predictive ability of the EVARUCI scale and COMHON index for pressure injury risk in critically ill patients: A diagnostic accuracy study.

BACKGROUND: Hospital-acquired pressure injuries are a costly and largely preventable complication occurring in a variety of acute care settings. Patients admitted to the intensive care unit are at greater risk of developing pressure injuries. OBJECTIVE: To determine whether the efficiency of scales to measure pressure injury risk increase when a continuously updated 3-day moving average method is used. METHODS: With a retrospective cohort design we recruited 3085 patients treated between June 2011 and February 2015 in the intensive care unit of a tertiary level university hospital. The present study included 2777 patients admitted to the Intensive Care Unit of the Hospital Universitario de Canarias, Spain. Patients were evaluated daily with two scales to measure pressure injury risk: the Current Risk Assessment Scale for Pressure injury in Intensive Care scale (EVARUCI scale) and the Conscious level-Mobility-Haemodynamics-Oxygenation-Nutrition Index (COMHON). The moving average was used to create a series of three day averages from the complete time-data set. The moving average method was used to analyze data points by creating series of averages of three days subsets of the time-data set. We calculated the efficiency of the method as the product of positive (PPV) and negative predicted values (NPV) for each scale. RESULTS: The efficiency using the moving average method was: PPV x NPV=0.483×0.907=0.438 (standard deviation=0.059), for EVARUCI Scale, and. PPV x NPV=0.552×0.806=0.445 (standard deviation=0.075) for COMHON Index. CONCLUSIONS: The efficiency using the moving average method was higher, than the efficiency of other methods previously reported (0.360±0.009 on average). The present study provides a useful procedure for nurses in clinical practice to assess whether a particular patient is protected against the appearance of pressure injury. The instrument should be used focusing on negative predictive value to indicate protection against pressure injury.