Predictive Validity of the Cubbin-Jackson and Braden Skin Risk Tools in Critical Care Patients: A Multisite Project

2021 ◽  
Vol 30 (2) ◽  
pp. 140-144
Author(s):  
Jill M. Delawder ◽  
Samantha L. Leontie ◽  
Ralitsa S. Maduro ◽  
Merri K. Morgan ◽  
Kathie S. Zimbro
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Assessment Tool ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Braden Scale ◽  
Skin Integrity

Background Patients in intensive care units are 5 times more likely to have skin integrity issues develop than patients in other units. Identifying the most appropriate assessment tool may be critical to preventing pressure injuries in intensive care patients. Objectives To validate the Cubbin-Jackson skin risk assessment in the critical care setting and to compare the predictive accuracy of the Cubbin-Jackson and Braden scales for the same patients. Methods In 5 intensive care units, the Cubbin-Jackson and Braden assessments were completed by different clinicians within 61 minutes of each other for 4137 patients between October 2017 and March 2018. Bivariate correlations and the Fisher exact test were used to check for associations between the scores. Results The Cubbin-Jackson and Braden scores were significantly and positively correlated (r = 0.80, P < .001). Both tools were significant predictors of skin changes and identified as “at risk” 100% of the patients who had a change in skin integrity occur. The specificity was 18.4% for the Cubbin-Jackson scale and 27.9% for the Braden scale, and the area under the curve was 0.75 (P < .001) for the Cubbin-Jackson scale and 0.76 (P < .001) for the Braden scale. These findings show acceptable construct validity for both scales. Conclusions The predictive validities of the Cubbin-Jackson and Braden scales are similar, but both are sub-optimal because of poor specificity and positive predictive value. Change in practice may not be warranted, because there are no differences between the 2 scales of practical benefit to bedside nurses.

scholarly journals Factors associated with admission to intensive care units in COVID-19 patients in Lyon-France

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0243709
Author(s):  
Philippe Vanhems ◽  
Marie-Paule Gustin ◽  
Christelle Elias ◽  
Laetitia Henaff ◽  
Cédric Dananché ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Medical Ward ◽  
Fisher Exact Test ◽  
Forward Selection ◽  
Multivariable Logistic Regression Model ◽  
Chi Square ◽  
Exact Test ◽  
Total Hospital Stay

Introduction A new respiratory virus, SARS-CoV-2, has emerged and spread worldwide since late 2019. This study aims at analysing clinical presentation on admission and the determinants associated with admission in intensive care units (ICUs) in hospitalized COVID-19 patients. Patients and methods In this prospective hospital-based study, socio-demographic, clinical and biological characteristics, on admission, of adult COVID-19 hospitalized patients presenting from the community for their first admission were prospectively collected and analysed. Characteristics of patients hospitalized in medical ward to those admitted in ICU were compared using Mann-Whitney and Chi-square or Fisher exact test when appropriate. Univariate logistic regression was first used to identify variables on admission that were associated with the outcome i.e. admission to an ICU versus total hospital stay in a medical ward. Forward selection was then applied beginning with sex, age and temperature in the multivariable logistic regression model. Results Of the 412 patients included, 325 were discharged and 87 died in hospital. Multivariable regression showed increasing odds of ICU hospitalization with temperature (OR, 1.56 [95% CI, 1.06–2.28] per degree Celsius increase), oxygen saturation <90% (OR, 12.45 [95% CI, 5.27–29.4]), abnormal lung auscultation on admission (OR, 3.58 [95% CI, 1.58–8.11]), elevated level of CRP (OR, 2.7 [95% CI, 1.29–5.66for CRP>100mg/L vs CRP<10mg/L). and monocytopenia (OR, 3.28 [95% CI, 1.4–7.68]) were also associated with increasing odds of ICU hospitalization. Older patients were less likely to be hospitalized in ICU (OR, 0.17 [95%CI, 0.05–0.51]. Conclusions Age and delay between onset of symptoms and hospital admission were associated with the risk of hospitalisation in ICU. Age being a fixed variable, interventions that shorten this delay would improve the prognosis of Covid-19 patients.

scholarly journals ESCALAS DE PREDIÇÃO DE RISCO PARA LESÃO POR PRESSÃO EM PACIENTES CRITICAMENTE ENFERMOS: REVISÃO INTEGRATIVA

2018 ◽  
Vol 9 (2) ◽  
Author(s):  
Ludmila Silva Castanheira ◽  
Andreza Werli-Alvarenga ◽  
Allana Dos Reis Correa ◽  
Daniela Mascarenhas de Paula Campos
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Risk Prediction ◽  
Pressure Ulcer ◽  
Critically Ill Patients ◽  
Skin Integrity ◽  
Pressure Injury ◽  
Terapia Intensiva

Resumo: Feridas afetam a integridade da pele, e quando não prevenidas ou tratadas podem levar a complicações decorrentes da integridade da pele prejudicada, especialmente em Unidades de Terapia Intensiva (UTIs). Atualmente, as escalas de predição de risco disponíveis para esta avaliação e validadas para o português são as de Braden, Waterlow e Norton. Objetivo: determinar qual a escala mais acurada para a avaliação de pacientes criticamente enfermos. Metodologia: Trata-se de uma revisão integrativa, cuja questão norteadora foi: qual escala para predição de risco para LP, disponível e validada para o português é mais acurada para estimar o risco de LP em pacientes criticamente enfermos internados na UTI? A busca dos estudos foi realizada na BVS, PubMed/MedLine e CINAHL. Resultados: Foram encontrados 134 artigos, elegíveis 123 e incluídos 18 na revisão. Conclusão: Os resultados apontam a necessidade da realização de estudos nesta área.Descritores: Úlcera por Pressão; Unidades de Terapia Intensiva; Cuidados Críticos; EscalasPREDICTION RISK SCALES FOR PRESSURE INJURY IN CRITICALLY ILL PATIENTS INTEGRATIVE REVIEWSummary: Wounds affect skin integrity, and when not prevented or treated can lead to complications resulting from impaired skin integrity, especially in intensive care units (ICUs). Currently, the prediction of risk scales available for this evaluation and validated for the Portuguese are Braden, Waterlow and Norton. Objective: to determine what the more accurate scale for the assessment of critically ill. Methodology: it is an integrative review, whose guiding question was: which to scale for risk prediction for LP, available and validated to Portuguese is more accurate for estimating the risk of LP in critically ill hospitalized in ICU? The search of the studies was held at the BVS, PubMed/MedLine and CINAHL. Results: found 134 items, 123 and included 18 eligible in the review. Conclusion: the results show the need of carrying out studies in this area.Descriptors: Pressure ulcer; Intensive Care Units; Critical Care; ScalesESCALAS DE PREDICCIÓN DE RIESGO PARA LESIÓN POR PRESIÓN EN PACIENTES CRÍTICAMENTE ENFERMOS: REVISIÓN INTEGRATIVAResumen: Las heridas afectan la integridad de la piel y cuando no prevenido o Tratado pueden conducir a las complicaciones resultantes de la integridad de la piel deteriorada, especialmente en unidades de cuidados intensivos (UCI). Actualmente, la predicción de las escalas de riesgo disponibles para esta evaluación y validadas para los portugueses son Braden, Waterlow y Norton. Objetivo: determinar la escala que más precisa para la evaluación de estado crítico. Metodología: ¿ es un examen integrador, cuyo rector era: que a la escala de predicción de riesgo de LP, disponible y validado al portugués es más exacta para estimar el riesgo de LP en críticamente enfermos hospitalizados en UCI? La búsqueda de los estudios se realizó en la BVS, PubMed/MedLine y CINAHL. Resultados: elegibles 18 134 artículos encontrados, 123 e incluido en la revisión. Conclusión: los resultados muestran la necesidad de llevar a cabo estudios en esta área.Descriptores: Úlcera por Presión, Unidades de Cuidados Intensivos, Cuidados Críticos, Escalas.

scholarly journals Paediatric admissions to a district general hospital adult intensive care unit over a six year period: A single centre retrospective case series, with review of practitioner confidence and competence in paediatric critical care

2021 ◽  
pp. 175114372110121
Author(s):  
Stephen A Spencer ◽  
Joanna S Gumley ◽  
Marcin Pachucki
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Case Series ◽  
Critically Ill Children ◽  
Single Centre ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Paediatric Critical Care ◽  
Doctors And Nurses

Background Critically ill children presenting to district general hospitals (DGH) are admitted to adult intensive care units (AICUs) for stabilisation prior to transfer to paediatric intensive care units (PICUs). Current training in PICU for adult intensive care physicians is only three months. This single centre retrospective case series examines the case mix of children presenting to a DGH AICU and a multidisciplinary survey assesses confidence and previous experience, highlighting continued training needs for DGH AICU staff. Methods all paediatric admissions to AICU and paediatric retrievals were reviewed over a 6-year period (2014-2019). Cases were identified from the Electronic Patient Record (EPR) and from data provided by the regional paediatric retrieval service. A questionnaire survey was sent to AICU doctors and nurses to assess confidence and competence in paediatric critical care. Results Between 2014-2019, 284 children were managed by AICU. In total 35% of cases were <1 y, 48% of cases were <2 y and 64% of cases were <5 y, and 166/284 (58%) children were retrieved. Retrieval reduced with increasing age (OR 0.49 [0.40-0.60], p < 0.0001). The survey had an 82% response rate, and highlighted that only 13% of AICU nurses and 50% of doctors had received prior PICU training. Conclusion At least one critically unwell child presents to the AICU each week. Assessment, stabilisation and management of critically unwell children are vital skills for DGH AICU staff, but confidence and competence are lacking. Formalised strategies are required to develop and maintain paediatric competencies for AICU doctors and nurses.

scholarly journals Early Prediction of Seven-Day Mortality in Intensive Care Unit Using a Machine Learning Model: Results from the SPIN-UTI Project

2021 ◽  
Vol 10 (5) ◽  
pp. 992
Author(s):  
Martina Barchitta ◽  
Andrea Maugeri ◽  
Giuliana Favara ◽  
Paolo Marco Riela ◽  
Giovanni Gallo ◽  
...  
Keyword(s):  
Machine Learning ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Learning Algorithm ◽  
Area Under The Curve ◽  
Support Vector ◽  
Icu Admission ◽  
Risk Of Death ◽  
Saps Ii ◽  
Svm Algorithm

Patients in intensive care units (ICUs) were at higher risk of worsen prognosis and mortality. Here, we aimed to evaluate the ability of the Simplified Acute Physiology Score (SAPS II) to predict the risk of 7-day mortality, and to test a machine learning algorithm which combines the SAPS II with additional patients’ characteristics at ICU admission. We used data from the “Italian Nosocomial Infections Surveillance in Intensive Care Units” network. Support Vector Machines (SVM) algorithm was used to classify 3782 patients according to sex, patient’s origin, type of ICU admission, non-surgical treatment for acute coronary disease, surgical intervention, SAPS II, presence of invasive devices, trauma, impaired immunity, antibiotic therapy and onset of HAI. The accuracy of SAPS II for predicting patients who died from those who did not was 69.3%, with an Area Under the Curve (AUC) of 0.678. Using the SVM algorithm, instead, we achieved an accuracy of 83.5% and AUC of 0.896. Notably, SAPS II was the variable that weighted more on the model and its removal resulted in an AUC of 0.653 and an accuracy of 68.4%. Overall, these findings suggest the present SVM model as a useful tool to early predict patients at higher risk of death at ICU admission.

Designing and Validity Evaluation of Quality of Nursing Care Scale in Intensive Care Units

2014 ◽  
Vol 22 (3) ◽  
pp. 461-471
Author(s):  
Mashaalah Zeraati ◽  
Negin Masoudi Alavi
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Nursing Care ◽  
Content Validity ◽  
Scale Level ◽  
Validity Index ◽  
Critical Care Units ◽  
Quality Of Nursing

Background and Purpose: Quality of nursing care measurement is essential in critical care units. The aim of this study was to develop a scale to measure the quality of nursing care in intensive care units (ICUs). Methods: The 68 items of nursing care standards in critical care settings were explored in a literature review. Then, 30 experts evaluated the items’ content validity index (CVI) and content validity ratio (CVR). Items with a low CVI score (<0.78) and low CVR score (<0.33) were removed from the scale. Results: The 50 items remained in the scale. The Scale level-CVI and Scale level-CVR were 0.898 and 0.725, respectively. Conclusion: The nursing care scale in ICU (Quality of Nursing Care Scale-ICU) that was developed in this research had acceptable CVI and CVR.

scholarly journals The challenges of using physical restraint in intensive care units in Iran: A qualitative study

2020 ◽  
pp. 175114371989278
Author(s):  
Zahra Salehi ◽  
Soodabeh Joolaee ◽  
Fatemeh Hajibabaee ◽  
Tahereh Najafi Ghezeljeh
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Qualitative Study ◽  
Intensive Care Units ◽  
Physical Restraint ◽  
Critical Care Nurses ◽  
Structured Interviews ◽  
Standard Equipment ◽  
Restraint Use ◽  
Ensure Patient Safety

Background Physical restraint is widely used in intensive care units to ensure patient safety, manage agitated patients, and prevent the removal of medical equipment connected to them. However, physical restraint use is a major healthcare challenge worldwide. Aim This study aimed to explore nurses' experiences of the challenges of physical restraint use in intensive care units. Methods This qualitative study was conducted in 2018–2019. Twenty critical care nurses were purposively recruited from the intensive care units of four hospitals in Tehran, Iran. Data were collected via in-depth semi-structured interviews, concurrently analyzed via Graneheim and Lundman's conventional content analysis approach, and managed via MAXQDA software (v. 10.0). Findings Three main themes were identified (i) organizational barriers to effective physical restraint use (lack of quality educations for nurses about physical restraint use, lack of standard guidelines for physical restraint use, lack of standard physical restraint equipment), (ii) ignoring patients' wholeness (their health and rights), and (iii) distress over physical restraint use (emotional and mental distress, moral conflict, and inability to find an appropriate alternative for physical restraint). Conclusion Critical care nurses face different organizational, ethical, and emotional challenges in using physical restraint. Healthcare managers and authorities can reduce these challenges by developing standard evidence-based guidelines, equipping hospital wards with standard equipment, implementing in-service educational programs, supervising nurses' practice, and empowering them for finding and using alternatives to physical restraint. Nurses can also reduce these challenges through careful patient assessment, using appropriate alternatives to physical restraint, and consulting with their expert colleagues.

scholarly journals Alarm Compliance in Healthcare: Design Considerations for Actionable Alarms (In Intensive Care Units)

2019 ◽  
Vol 1 (1) ◽  
pp. 839-846
Author(s):  
Rosana Sanz-Segura ◽  
Eduardo Manchado Pérez ◽  
Elif Özcan
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intrinsic Motivation ◽  
Intensive Care Units ◽  
Design Strategies ◽  
Alarm Fatigue ◽  
Healthcare Design ◽  
Design Considerations ◽  
Potential Success ◽  
Per Se

AbstractIntensive care units are technologically advanced environments that are designed to safeguard the patient while their vitals are stabilized for further treatment. Audible and visual alarms are part of the healthcare ecology. However, these alarms are so many that clinicians suffer from a syndrome called ‘alarm fatigue’ and often do not comply with the task alarm is conveying. Measuring compliance with rules in the workspace and determining the success of a system belongs to the field of ergonomics and is based on data collected through task observations and scoring. In this paper, we will explore compliance with critical alarms by not only from their potential success or failure perspective but also from the perspectives of the clinician capacity, needs, and motivations to comply with alarms in critical environments. We will finally, reflect on further possible design strategies to increase compliance in critical care that are beyond following rules per se but through intrinsic motivation.

scholarly journals Predictive Validity of the Braden Scale for Patients in Intensive Care Units

2013 ◽  
Vol 22 (6) ◽  
pp. 514-520 ◽  
Author(s):  
S. Hyun ◽  
B. Vermillion ◽  
C. Newton ◽  
M. Fall ◽  
X. Li ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Predictive Validity ◽  
Braden Scale

Critical care in Colombia: Differences between teaching and nonteaching intensive care units. A prospective cohort observational study

2012 ◽  
Vol 27 (1) ◽  
pp. 104.e9-104.e17 ◽  
Author(s):  
Sandra Rubiano ◽  
Fabian Gil ◽  
Edgar Celis-Rodriguez ◽  
Henry Oliveros ◽  
Gabriel Carrasquilla
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Observational Study ◽  
Intensive Care Units ◽  
Prospective Cohort

Procedures in the Adult and Neonatal Intensive Care Units

2018 ◽  
Author(s):  
Matthew Read ◽  
Christopher V. Maani
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Operating Room ◽  
Intensive Care Units ◽  
Surgical Procedures ◽  
Neonatal Intensive Care ◽  
Critical Care Medicine ◽  
Neonatal Intensive Care Units ◽  
Anesthesia Practice ◽  
Urgent Procedure

Bedside procedures in the ICU are an integral component of critical care medicine. Anesthesiologists who are assigned to the ICU must adapt principles of safe and effective anesthesia practice to this novel outside-of-the-operating-room environment. There are several reasons for surgical procedures to sometimes be performed at the bedside in the ICU, such as the avoidance of transporting unstable patients from the ICU to the OR, or the lack of adequate time to mobilize resources to perform an urgent procedure in the OR. Readiness of the entire ICU team is essential to avoid compromising care due to production pressure or lack of standards routine to the OR environment. This chapter discusses the types of procedures performed in the ICU and reviews the requirements of performing them successfully.

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