外部验证CALCULATE量表预测重症监护病房老年患者压力性损伤的价值  

The value of CALCULATE scale in predicting pressure injury in elderly patients in intensive care units based on external validation

作　　者：徐英 瞿春华 瞿海红 陈莉 郑艳丽 Xu Ying;Qu Chunhua;Qu Haihong;Chen Li;Zheng Yanli(Department of Nursing,Shanghai Pudong Hospital,Shanghai,201399,P.R.China;Department of Outpatient and Emergency Medicine,Shanghai Pudong Hospital,Shanghai,201399,P.R.China;Department of Intensive Care Medicine,Shanghai Pudong Hospital,Shanghai,201399,P.R.China)

机构地区：[1]上海市浦东医院护理部,上海201399 [2]上海市浦东医院门急诊部,上海201399 [3]上海市浦东医院重症医学科,上海201399

出　　处：《老年医学与保健》2023年第5期1045-1051,共7页Geriatrics & Health Care

基　　金：2020年度上海市卫生健康委员会科研项目(202040201);2023年度上海市浦东新区卫生健康委员会卫生科技项目(PW2023A-04);2021复旦大学—复星护理科研基金(FNF202131);2022年度上海市浦东新区卫生系统学科建设重要薄弱学科项目(PWZbr2022-20)。

摘　　要：目的通过外部验证评估CALCULATE量表预测ICU老年患者压力性损伤(PI)的价值。方法回顾性分析上海市浦东医院综合ICU内2018年1月-2018年12月收治的老年患者临床资料,根据ICU期间是否发生PI分为PI组和非PI组。从区分度,校准度和有效性等方面评估CALCULATE量表的效能。结果最终纳入研究老年患者614例,ICU期间发生PI患者70例(11.4%),大部分是1、2期(97.1%),最常见部位是骶尾部(77.3%),CALCULATE量表预测PI的AUC为0.724(95%CI:0.687~0.759),优于传统的Braden量表的AUC(0.633)(95%CI:0.594~0.672),统计值Z=6.326(P<0.001);多因素二元Logistic回归显示,CALCULATE量表评分大于3分是独立危险因素(OR=3.835,95%CI:2.522~5.832,P<0.001);Hosmer-Lemeshow检验显示,CALCULATE量表的校准度较差(χ^(2)=15.103,P=0.004),决策曲线分析显示,CALCULATE量表具有较好的临床应用效能。结论CALCULATE量表预测ICU老年患者PI有一定的价值,但仍有待进一步完善。Objective To evaluate the value of the Critical Care Pressure Ulcer Assessment Tool made Easy(CALCULATE)scale in predicting pressure injury(PI)in elderly ICU patients by external validation.Methods The clinical data of elderly patients admitted to the comprehensive ICU of Shanghai Pudong Hospital from January 2018 to December 2018 were retrospectively analyzed.They were divided into PI group and non-PI group according to whether PI occurred during ICU.The performance of the CALCULATE scale was evaluated from the aspects of discrimination,calibration and validity.Results A total of 614 elderly patients were included in the study.During their stay in the ICU,70 patients(11.4%)developed PIs,most of which were in stage 1 and 2(97.1%),and the most common site was sacrococcygeal region(77.3%).The area under the curve(AUC)of CALCULATE scale for predicting PI was 0.724(95%CI:0.687-0.759),outperforming the AUC of traditional Braden scale(0.633)(95%CI:0.594-0.672),with a statistical value of Z=6.326(P<0.001).Logistic regression analysis demonstrated that scores of CALCULATE scale more than 3 was an independent risk factor(OR=3.835,95%CI:2.522-5.832,P<0.001).Hosmer-Lemeshow test suggested poor calibration for CALCULATE scale(χ^(2)=15.103,P=0.004).Decision curve analysis illustrated the favorable clinical application efficacy of the CALCULATE scale.Conclusion The CALCULATE scale has some value in predicting PI in elderly ICU patients,but it still needs to be further improved.

关 键 词：老年 压力性损伤 重症监护病房 CALCULATE量表 BRADEN量表 

分 类 号：R459.7[医药卫生—急诊医学]