Avaliação da acurácia das escalas CALCULATE e Braden na predição do risco de lesão por pressão em unidade de terapia intensiva
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2018-02-22
Autores
Saranholi, Taís Lopes
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Universidade Estadual Paulista (Unesp)
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Introdução: As lesões por pressão (LP) são áreas de lesões localizadas na pele, geralmente sobre uma proeminência óssea, resultantes da pressão prolongada dos tecidos moles contra a superfície externa e estão frequentemente presentes nas unidades críticas de internação, portanto predizer quais os pacientes mais vulneráveis a este problema é fundamental. Existem diversas escalas de avaliação, que podem auxiliar no diagnóstico de um grupo de risco para LP. A Escala de Braden (EB) é um instrumento norte-americano para identificar o risco para o desenvolvimento de LP, sendo amplamente utilizada em diversos pacientes tanto no serviço de saúde quanto no domicílio. A escala CALCULATE foi desenvolvida especialmente para a utilização nos pacientes das unidades de terapia intensiva (UTIs), a partir de suas condições, resultando no risco alto ou muito alto para o desenvolvimento da LP. Objetivos: Comparar a acurácia da EB e da CALCULATE para predizer o risco de lesão por pressão em pacientes internados em uma unidade de terapia intensiva e compará-las. Método: Estudo tipo coorte prospectivo e analítico. Realizado inicialmente concordância interpessoal da EB e da escala CALCULATE. Após isto, a coleta de dados foi realizada nos pacientes internados em uma UTI de adultos de um hospital público de referência, dentro dos critérios de inclusão, até surgimento da LP estágio 1, alta da UTI ou óbito. Foram coletadas dados referentes as características demográficas, clínicas, escores das EB e CALCULATE (nas primeiras 24h da internação e após a cada 48 horas), medidas preventivas adotadas e características das LP nos casos que desenvolveram este agravo. A concordância interpessoal entre os escores pelos enfermeiros foi avaliada pelo coeficiente de correlação intraclasse e o desempenho das escalas quanto à predição de LP foi realizado por meio da curva ROC e cálculo da área sob a curva, sendo considerado desempenho satisfatório quando a área sob a curva for maior do que 0,7. Resultados: Ambas as escalas foram reprodutíveis na concordância interpessoal realizada inicialmente. Foram incluídos 100 participantes, sendo 62% sexo masculino, média de idade de 59 anos (DP±17,4), com tempo médio de internação de 7 dias (DP±5,2). As medidas preventivas adotadas foram mudança de decúbito a cada 2 horas (99%) e hidratação da pele (100%). Apenas para alguns pacientes (39%) foi utilizado colchão tipo piramidal. Houve 37 LP em 35 participantes. O local que mais ocorreu LP foi na região sacral. A maioria das lesões foram de estágio 1 (24%). Como intervenção pós LP foi realizado a intensificação da mudança de decúbito. Outros desfechos dos participantes foram: 45 altas e 20 óbitos. O desempenho da CALCULATE quanto a predição de LP foi melhor do que a EB, com área sob a curva de 0,74 (IC 95% 0,64 - 0,83) e 0,61 (IC 95% 0,50 - 0,72) respectivamente. Conclusão: A escala CALCULATE apresentou melhor acurácia na predição de LP nos pacientes adultos da UTI, quando comparada com a EB.
Introduction: Pressure lesions (LP) are lesion areas located on the skin, usually on a prominent bone, resulting from prolonged soft tissue pressure against the external surface and are frequently present in the critical units of hospitalization, thus predicting which patients are most vulnerable to this problem is fundamental. There are several scales of evaluation, which may help in the diagnosis of a risk group for LP. The Braden Scale (EB) is an American instrument to identify the risk factor for the development of LP, and is widely used in several patients, both in the health service and at home. The CALCULATE scale was specially developed for use in patients of intensive care units (ICUs), from their conditions resulting in high or very high risk for the development of LP. Objectives: To compare the accuracy of EB and CALCULATE to predict the risk of pressure injury in patients admitted to an intensive care unit and to compare them. Method: Prospective and analytical cohort study. Interpersonal agreement of the EB and the CALCULATE scale was initially performed. After this, the data collection was performed in patients admitted to an adult ICU of a public reference hospital, within the inclusion criteria, until the appearance of category 1 LP, discharge from the ICU or death. The demographic, clinical, EB and CALCULATE scores were collected (in the first 24 hours of hospitalization and after every 48 hours), preventive measures adopted and characteristics of LP in the cases that developed this illness. The interpersonal agreement between the scores by the nurses was evaluated by the intraclass correlation coefficient and the performance of the scales as for the LP prediction was performed by means of the ROC curve and the calculation of the area under the curve, being considered a satisfactory performance when the area under the curve is greater than 0.7. Results: Both scales were reproducible in the interpersonal agreement performed initially. A total of 100 participants were included, 62% male, mean age 59 years (SD ± 17.4), with an average length of hospital stay of 7 days (SD ± 5.2). The preventive measures adopted were change of position every 2 hours (99%) and skin hydration (100%). Only a few patients (39%) used a pyramidal type mattress. There were 37 LPs in 35 participants. The place that most occurred LP was in the sacral region. The majority of injuries were category 1 (24%). As a post-LP intervention, the change in decubitus was intensified. Other outcomes of the participants were: 45 high and 20 deaths. The performance of CALCULATE in predicting LP was better than EB, with area under the curve of 0.74 (CI 95% 0.64 - 0.83) and 0.61 (CI 95% 0.50 - 0.72) respectively. Conclusion: The CALCULATE scale presented better accuracy in LP prediction in adult ICU patients, when compared to EB
Introduction: Pressure lesions (LP) are lesion areas located on the skin, usually on a prominent bone, resulting from prolonged soft tissue pressure against the external surface and are frequently present in the critical units of hospitalization, thus predicting which patients are most vulnerable to this problem is fundamental. There are several scales of evaluation, which may help in the diagnosis of a risk group for LP. The Braden Scale (EB) is an American instrument to identify the risk factor for the development of LP, and is widely used in several patients, both in the health service and at home. The CALCULATE scale was specially developed for use in patients of intensive care units (ICUs), from their conditions resulting in high or very high risk for the development of LP. Objectives: To compare the accuracy of EB and CALCULATE to predict the risk of pressure injury in patients admitted to an intensive care unit and to compare them. Method: Prospective and analytical cohort study. Interpersonal agreement of the EB and the CALCULATE scale was initially performed. After this, the data collection was performed in patients admitted to an adult ICU of a public reference hospital, within the inclusion criteria, until the appearance of category 1 LP, discharge from the ICU or death. The demographic, clinical, EB and CALCULATE scores were collected (in the first 24 hours of hospitalization and after every 48 hours), preventive measures adopted and characteristics of LP in the cases that developed this illness. The interpersonal agreement between the scores by the nurses was evaluated by the intraclass correlation coefficient and the performance of the scales as for the LP prediction was performed by means of the ROC curve and the calculation of the area under the curve, being considered a satisfactory performance when the area under the curve is greater than 0.7. Results: Both scales were reproducible in the interpersonal agreement performed initially. A total of 100 participants were included, 62% male, mean age 59 years (SD ± 17.4), with an average length of hospital stay of 7 days (SD ± 5.2). The preventive measures adopted were change of position every 2 hours (99%) and skin hydration (100%). Only a few patients (39%) used a pyramidal type mattress. There were 37 LPs in 35 participants. The place that most occurred LP was in the sacral region. The majority of injuries were category 1 (24%). As a post-LP intervention, the change in decubitus was intensified. Other outcomes of the participants were: 45 high and 20 deaths. The performance of CALCULATE in predicting LP was better than EB, with area under the curve of 0.74 (CI 95% 0.64 - 0.83) and 0.61 (CI 95% 0.50 - 0.72) respectively. Conclusion: The CALCULATE scale presented better accuracy in LP prediction in adult ICU patients, when compared to EB
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Palavras-chave
Úlcera por pressão, Enfermeiros, Cuidados de enfermagem, Escalas e avaliação de risco, Pressure ulcer, Nurses, Nursing care, Scales and risk assessment