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      Validade preditiva da escala de Braden para pacientes de terapia intensiva Translated title: Validez predictiva de la escala de Braden para pacientes de Cuidados Intensivos Translated title: Predictive validity of the Braden Scale for patients in intensive care

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          Abstract

          OBJETIVOS: Avaliar a validade preditiva dos escores da escala de Braden em pacientes de um Centro de Terapia Intensiva e descrever as medidas preventivas implementadas pela equipe de enfermagem. MÉTODOS: Estudo prospectivo descritivo cujos dados foram coletados por meio de prontuário, exame físico e aplicação da Escala de Braden em 23 pacientes. RESULTADOS: O resultado dos testes de validade preditiva apontou os escores 14, 13 e 12 como os mais eficientes na predição de risco para úlcera por pressão, nas primeira, segunda e terceira avaliações, com seus respectivos valores de sensibilidade (95%, 95% e 94%) e especificidade (45%, 55% e 77%). CONCLUSÃO: Concluiu-se que a escala de Braden é um instrumento eficiente para identificar precocemente o risco e para subsidiar a elaboração de um plano de cuidado capaz de prevenir danos na pele de pacientes em estado críticos.

          Translated abstract

          OBJETIVOS: Evaluar la validez predictiva de los escores de la escala de Braden en pacientes de un Centro de Cuidados Intensivos y describir las medidas preventivas implementadas por el equipo de enfermería. MÉTODOS: Estudio prospectivo descriptivo cuyos datos fueron recolectados por medio de la historia clínica, examen físico y la aplicación de la Escala de Braden a 23 pacientes. RESULTADOS: El resultado de los tests de validez predictiva apuntó los escores 14, 13 y 12 como los más eficientes en la predicción de riesgo para úlcera por presión, en las primera, segunda y tercera evaluaciones, con sus respectivos valores de sensibilidad (95%, 95% y 94%) y especificidad (45%, 55% e 77%). CONCLUSIÓN: Se concluyó que la escala de Braden es un instrumento eficiente para identificar precozmente el riesgo y para subsidiar la elaboración de un plan de cuidados capaz de prevenir daños en la piel de pacientes en estado crítico.

          Translated abstract

          OBJECTIVES: To evaluate the predictive validity of the Braden Scale scores in patients in an intensive care unit and to describe the preventive measures implemented by the nursing staff. METHODS: A prospective, descriptive study with data collected from medical records, physical examination, and application of the Braden Scale in 23 patients. RESULTS: The results of tests of predictive validity produced scores of 14, 13 and 12 with the most efficient in predicting risk for pressure ulcers, in the first, second and third assessments, with their respective values of sensitivity (95%, 95% and 94%) and specificity (45%, 55% and 77%). CONCLUSION: We concluded that the Braden Scale is an efficient tool for early identification of risk and to support the development of a plan of care to prevent skin damage in critically ill patients.

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          Most cited references22

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          Preventing pressure ulcers: a systematic review.

          Pressure ulcers are common in a variety of patient settings and are associated with adverse health outcomes and high treatment costs. To systematically review the evidence examining interventions to prevent pressure ulcers. MEDLINE, EMBASE, and CINAHL (from inception through June 2006) and Cochrane databases (through issue 1, 2006) were searched to identify relevant randomized controlled trials (RCTs). UMI Proquest Digital Dissertations, ISI Web of Science, and Cambridge Scientific Abstracts were also searched. All searches used the terms pressure ulcer, pressure sore, decubitus, bedsore, prevention, prophylactic, reduction, randomized, and clinical trials. Bibliographies of identified articles were further reviewed. Fifty-nine RCTs were selected. Interventions assessed in these studies were grouped into 3 categories, ie, those addressing impairments in mobility, nutrition, or skin health. Methodological quality for the RCTs was variable and generally suboptimal. Effective strategies that addressed impaired mobility included the use of support surfaces, mattress overlays on operating tables, and specialized foam and specialized sheepskin overlays. While repositioning is a mainstay in most pressure ulcer prevention protocols, there is insufficient evidence to recommend specific turning regimens for patients with impaired mobility. In patients with nutritional impairments, dietary supplements may be beneficial. The incremental benefit of specific topical agents over simple moisturizers for patients with impaired skin health is unclear. Given current evidence, using support surfaces, repositioning the patient, optimizing nutritional status, and moisturizing sacral skin are appropriate strategies to prevent pressure ulcers. Although a number of RCTs have evaluated preventive strategies for pressure ulcers, many of them had important methodological limitations. There is a need for well-designed RCTs that follow standard criteria for reporting nonpharmacological interventions and that provide data on cost-effectiveness for these interventions.
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            Risk assessment scales for pressure ulcer prevention: a systematic review.

            This paper reports a systematic review conducted to determine the effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice, degree of validation of risk assessment scales, and effectiveness of risk assessment scales as indicators of risk of developing a pressure ulcer. Pressure ulcers are an important health problem. The best strategy to avoid them is prevention. There are several risk assessment scales for pressure ulcer prevention which complement nurses' clinical judgement. However, some of these have not undergone proper validation. A systematic bibliographical review was conducted, based on a search of 14 databases in four languages using the keywords pressure ulcer or pressure sore or decubitus ulcer and risk assessment. Reports of clinical trials or prospective studies of validation were included in the review. Thirty-three studies were included in the review, three on clinical effectiveness and the rest on scale validation. There is no decrease in pressure ulcer incidence was found which might be attributed to use of an assessment scale. However, the use of scales increases the intensity and effectiveness of prevention interventions. The Braden Scale shows optimal validation and the best sensitivity/specificity balance (57.1%/67.5%, respectively); its score is a good pressure ulcer risk predictor (odds ratio = 4.08, CI 95% = 2.56-6.48). The Norton Scale has reasonable scores for sensitivity (46.8%), specificity (61.8%) and risk prediction (OR = 2.16, CI 95% = 1.03-4.54). The Waterlow Scale offers a high sensitivity score (82.4%), but low specificity (27.4%); with a good risk prediction score (OR = 2.05, CI 95% = 1.11-3.76). Nurses' clinical judgement (only considered in three studies) gives moderate scores for sensitivity (50.6%) and specificity (60.1%), but is not a good pressure ulcer risk predictor (OR = 1.69, CI 95% = 0.76-3.75). There is no evidence that the use of risk assessment scales decreases pressure ulcer incidence. The Braden Scale offers the best balance between sensitivity and specificity and the best risk estimate. Both the Braden and Norton Scales are more accurate than nurses' clinical judgement in predicting pressure ulcer risk.
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              Pressure ulcers: validation of two risk assessment scales.

              To compare the predictive value of two pressure ulcer risk assessment scales (Braden and Norton) and of clinical judgement. To evaluate the impact of effective preventive measures on the predictive validity of the two risk assessment scales. Of the 1772 participating older patients, 314 were randomly selected and assigned to the 'turning' group; 1458 patients were assigned to the "non-turning" group. Using the Braden and the Norton scale the pressure ulcer risk was scored twice weekly during a four-week period. Clinical assessment was monitored daily. The patients at risk in the "turning" group (Braden score <17 or Norton score <12) were randomly assigned to a two-hour turning schedule or to a four-hour turning schedule in combination with a pressure-reducing mattress. The "non-turning" group received preventive care based on the clinical judgement of the nurses. The diagnostic accuracy was similar for both scales. If nurses act according to risk assessment scales, 80% of the patients would unnecessarily receive preventive measures. The use of effective preventive measures decreased the predictive value of the risk assessment scales. Nurses predicted pressure ulcer development less well than the Braden and the Norton scale. Only activity, sensory perception, skin condition and existence of old pressure ulcers were significant predictors of pressure ulcer lesions. The effectiveness of the Norton and Braden scales is very low. Much needless work is done and expensive material is wrongly allocated. The use of effective preventive measures decreases the predictive value of the risk assessment scales. Although the performance of the risk assessment scales is poor, using a risk assessment tool seems to be a better alternative than relying on the clinical judgement of the nurses.

                Author and article information

                Journal
                ape
                Acta Paulista de Enfermagem
                Acta paul. enferm.
                Escola Paulista de Enfermagem, Universidade Federal de São Paulo (São Paulo, SP, Brazil )
                0103-2100
                1982-0194
                2011
                : 24
                : 6
                : 772-777
                Affiliations
                [01] Cuiabá MT orgnameMato Grosso orgdiv1Centro Estadual de Referência de Média e Alta Complexidade orgdiv2Ambulatório de Dermatologia Sanitária Brasil
                [02] Ribeirão Preto SP orgnameUniversidade de São Paulo orgdiv1Especializada da Escola de Enfermagem de Ribeirão Preto orgdiv2Departamento de Enfermagem Geral Brasil
                Article
                S0103-21002011000600007 S0103-2100(11)02400607
                76fb38c2-b966-406d-92b4-14133425a343

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 11 June 2010
                : 17 August 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 22, Pages: 6
                Categories
                Artigos Originais

                Úlcera por pressão,Pacientes internados,Unidades de Terapia Intensiva,Valor preditivo dos testes,Pressure ulcer,Inpatients,Intensive care units,Predictive value of tests,Sensitivity and specificity,Úlcera por presión,Pacientes internos,Unidades de terapia intensiva,Valor predictivo de las pruebas,Sensibilidad y Especificidad,controle

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