Abstract

PANCORBO-HIDALGO, Pedro L.; GARCIA-FERNANDEZ, Francisco P.; SOLDEVILLA-AGREDA, J. Javier  and  MARTINEZ-CUERVO, Fernando. Pressure ulcers risk assessment: Clinical practice in Spain and a meta-analysis of scales effectiveness. Gerokomos [online]. 2008, vol.19, n.2, pp.40-54. ISSN 1134-928X.

Aims: 1) To update knowledge about pressure ulcers risk assessment scales (RAS): validation, efficacy and risk prediction. 2) To identify the methods for pressure ulcers risk assessment in actual clinical practice in Spain. Methods: For the first objective, a systematic review of validation studies with meta-analysis was carried out. The search was made on 14 bibliographic databases using "pressure ulcers", "decubitus ulcers","risk assessment" and its combinations as descriptors. The CASP instrument was used for critical assessment of retrieved studies. Validation data was extracted for each scale and a meta-analysis was performed for RAS with 2 or more published studies. For the second objective, a survey was carried out among nurses belonging to PU committees. Results: 44 studies with validation data on 17 RAS were selected. Only 5 RAS have two or more validation studies: Braden, Cubbin-Jackson, EMINA, Norton and Waterlow. The best predictive RAS were Braden (OR = 5.10) and EMINA (OR = 7.14). Nurses' clinical judgement alone is not a good PU risk predictor. For critical care patients the best predictive RAS were: Cubbin-Jackson (OR = 6.663) and Braden (OR = 3.02). Most of surveyed nurses (67.3%) stated that they assessed always PU risk; usually (46.2%) using a RAS. Braden, Norton, Norton-modified, Cubbin-Jackson and EMINA, in this order, were the most used RAS in Spain. Number and types of preventive measures were related with patients' PU risk. Conclusions: Braden, EMINA and Norton were the RAS with best validation and prediction indicators. Anyone of theses scales perform better that clinical judgment alone in PU risk prediction. Braden and Cubbin-Jackson were the best RAS for critical care. Among the Spanish nurses surveyed PU risk assessment is a usual practice and most of them used Braden or Norton scales.

Keywords : Pressure ulcers; risk assessment scales; systematic review; meta-analysis; clinical practice.

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