Objectives: This study was designed to test and validate the new LPD scale in a home care setting. The specific objectives are to validate the LPD scale for subjects cared for at home; and to compare LPD to the Braden scale for internal validity. Method: This multicenter, cross-sectional study was conducted in the domestic environment of subjects cared for Home Care services from North to South of Italy. Data collection lasted 8 months, between June 2018 and September 2020, and consisted of the simultaneous compilation of the new LPD, and the Braden scale. Home Care Expert nurses could interface with the recruited subjects and/or caregivers. The parameters considered to validate the new scale were sensitivity (Se), specificity (Sp), positive predictive values (PPV), odds ratio (OR), and the area under the receiver operating characteristic (ROC) curve. Results: Of the 679 recruited subjects, 63.2% were women, and more than 50% did not have a pressure ulcer. 48.2% of the sample aged over 85 years old; 69% was affected by multiple disease, and 76.6% took a lot of drugs. 91.6% of the subjects were affected by a partial or total functional dependency. Around 50% of subjects presented double incontinence, and 43% were conscious and collaborated. 85.4% of subjects lived in a healthy environment. The predictive validity parameters showed: Se 77.25%, Sp 84.04%, PPV 91.37%, and the area under the curve (AUC) 0.88% with a confidence interval (CI) 95%. These values mean a moderately accuracy of the test. Conclusions: The new LPD scale has demonstrated a good capacity for identifying the subjects at risk of pressure ulcer and had a better discriminatory power rather than Braden scale.
References
[1]
Black, J., Baharestani, M., Cuddigan, J., et al. (2007) National Pressure Ulcer Advisory Panel’s Updated Pressure Ulcer Staging System. Advances in Skin & Wound Care, 20, 269-274. https://doi.org/10.1097/01.ASW.0000269314.23015.e9
[2]
Bernabei, R., Manes-Gravina, E. and Mammarella, E. (2011) Epidemiologia delle piaghe da decubito. The Journal of Gerontology and Geriatrics, 59, 237-243.
[3]
Ayello, E.A. and Braden, B. (2002) How and Why to Do Pressure Ulcer Risk Assessment. Advances in Skin & Wound Care, 15, 125-131. https://doi.org/10.1097/00129334-200205000-00008
[4]
Bauer, K., Rock, K., Nazzal, M., et al. (2016) Pressure Ulcers in the United States Inpatient Population from 2008 to 2012: Results of a Retrospective Nationwide Study. Ostomy Wound Management, 62, 30-38.
[5]
Registered Nurses Association of Otranto. (2002) Risk Assessment & Prevention of Pressure Ulcers. RNAO.
[6]
AHRQ (2012) Pressure Ulcer Risk Assessment and Prevention: A Comparative Effectiveness Review. AHRQ.
[7]
Olivo, S., Canova, C., Peghetti, A., Rossi, M. and Zanotti, R. (2020) Prevalence of Pressure Ulcers in Hospitalised Patients: A Cross-Sectional Study. Journal of Wound Care, 29, 20-28. https://doi.org/10.12968/jowc.2020.29.Sup3.S20
[8]
Eberlein-Gonska, M., Petzold, T., Helass, G., et al. (2013) The Incidence and Determinants of Decubitus Ulcers in Hospital Care: An Analysis of Routine Quality Management Data at a University Hospital. Deutsches Ärzteblatt International, 110, 550-556. https://doi.org/10.3238/arztebl.2013.0550
[9]
Jiang, Q., Li, X., Qu, X., et al. (2014) The Incidence, Risk Factors and Characteristics of Pressure Ulcers in Hospitalized Patients in China. International Journal of Clinical and Experimental Pathology, 7, 2587-2594.
[10]
Russo, C.A., Steiner, C. and Spector, W. () Hospitalizations Related to Pressure Ulcers Among Adults 18 Years and Olders 2006. In: Healthcare Cost and Utilization Project (HCUP), Statistical Brief 64, Agency for Healthcare Research and Quality, Rockville.
[11]
Pancorbo-Hidalgo, P.L., Garcia-Fernandez, F.P., Lopez-Mdina, I.M. and Alvarez-Nieto, C. (2006) Risk Assessment Scales for Pressure Ulcer Prevention: A Systematic Review. Journal of Advanced Nursing, 54, 94-110. https://doi.org/10.1111/j.1365-2648.2006.03794.x
[12]
Kring, D.L. (2007) Reliability and Validity of the Braden Scale for Predicting Pressure Ulcer Risk. Journal of Wound, Ostomy & Continence Nursing, 34, 399-406. https://doi.org/10.1097/01.WON.0000281656.86320.74
[13]
Betes, J. and Barbara, M. (2001) Quality Indicators for Prevention and Management of Pressure Ulcers in Vulnerable Elders. Annals of Internal Medicine, 135, 744-751. https://doi.org/10.7326/0003-4819-135-8_Part_2-200110161-00014
[14]
Bergquist, S. and Frantz, R. (1999) Pressure Ulcers in Community-Based Older Adults Receiving Home Health Care. Prevalence, Incidence and Associated Risk Factors. Advanced in Wound Care, 12, 339-351
[15]
Magnan, M.A. and Maklebust, J. (2009) Braden Scale Risk Assessment and Pressure Ulcer Prevention Planning: What’s the Connection? Journal of Wound, Ostomy and Continence Nursing, 36, 622-634. https://doi.org/10.1097/WON.0b013e3181bd812c
[16]
World Union of Wound Healing Societies (WUWHS) (2016) Florence Congress. Position Document. Advances in Wound Care: The Triangle of Wound Assessment Wounds International.
[17]
Park-Lee, E. and Caffrey, C. (2009) Pressure Ulcers among Nursing Home Residents: United States, 2004. NCHS Data Brief, No. 14, 1-8.
[18]
Lindgren, M., Unosson, M. and Fredrikson, M. (2004) Immobility—A Major Risk Factor for Development of Pressure Ulcers among Adult Hospitalized Patients: A Prospective Study. Scandinavian Journal of Caring Sciences, 18, 57-64. https://doi.org/10.1046/j.0283-9318.2003.00250.x
[19]
Allman, R.M. (1997) Pressure Ulcer Prevalence, Incidence, Risk Factors and Impact. Clinic in Geriatric Medicine, 13, 21-436. https://doi.org/10.1016/S0749-0690(18)30152-6
[20]
Smelzer, S.C., Bare, G.B., Hinkle, J.L. and Nebuloni, G. (2011) Principi e pratiche riabilitative. In: Hinkle, J.L. and Cheever, K.H., Eds., Brunner & Suddarth. Infermieristica Medico-Chirurgica, 4th Edtion, Ambrosiana, Milano.
[21]
Brandeis, G.H., Ooi, W.L., Hossain, M., et al. (1994) A Longitudinal Study of Risk Factors Associated with the Formation of Pressure Ulcers in Nursing Homes. Journal of the American Geriatric Society, 42, 388-393. https://doi.org/10.1111/j.1532-5415.1994.tb07486.x
[22]
Defloor, T. and Grypdonck, M.F. (2005) Pressure Ulcers: Validation of Two Risk Assessment Scales. Journal of Clinical Nursing, 14, 373-382. https://doi.org/10.1111/j.1365-2702.2004.01058.x
[23]
Borghardt, A.T., Prado, T.N., Araujo, T.M., et al. (2015) Evaluation of the Pressure Ulcers Risk Scales with Critically Ill Patients: A Prospective Cohort Study. Revista Latino-Americana de Enfermagem, 23, 28-35. https://doi.org/10.1590/0104-1169.0144.2521
[24]
Anthony, D., Parboteeah, S., Saleh, M. and Papanikolaou, P. (2008) Norton, Waterlow and Braden Scores: A Review of the Literature and a Comparison between the Scores and Clinical Judgement. Journal of Clinical Nursing, 17, 646-653. https://doi.org/10.1111/j.1365-2702.2007.02029.x
[25]
Ash, D. (2002) An Exploration of the Occurence of Pressure Ulcers in a British Spinal Injuries Unit. Journal of Clinical Nursing, 11, 470-478. https://doi.org/10.1046/j.1365-2702.2002.00603.x
[26]
Eriksson, E., Hietanen, H. and Asko-Sljavaara, S. (2000) Prevalence and Characteristics of Pressure Ulcers. A One-Day Patient Population in a Finnish City. Clinical Nurse Specialist, 14, 119-125. https://doi.org/10.1097/00002800-200005000-00006
[27]
Perkins, N.J. and Schisterman, E.F. (2006) The Inconsistency of “Optimal” Cutpoints Obtained Using Two Criteria Based on the Receiver Operating Characteristic Curve. American Journal of Epidemiology, 163, 670-675. https://doi.org/10.1093/aje/kwj063
[28]
Swets, J.A. (1979) ROC Analysis Applied to the Evaluation of Medical Imaging Techniques. Investigative Radiology, 14, 109-121. https://doi.org/10.1097/00004424-197903000-00002
