Predictive ability of the EVARUCI scale and COMHON index for pressure injury risk in critically ill patients: A diagnostic accuracy study.

BACKGROUND: Hospital-acquired pressure injuries are a costly and largely preventable complication occurring in a variety of acute care settings. Patients admitted to the intensive care unit are at greater risk of developing pressure injuries.

OBJECTIVE: To determine whether the efficiency of scales to measure pressure injury risk increase when a continuously updated 3-day moving average method is used.

METHODS: With a retrospective cohort design we recruited 3085 patients treated between June 2011 and February 2015 in the intensive care unit of a tertiary level university hospital. The present study included 2777 patients admitted to the Intensive Care Unit of the Hospital Universitario de Canarias, Spain. Patients were evaluated daily with two scales to measure pressure injury risk: the Current Risk Assessment Scale for Pressure injury in Intensive Care scale (EVARUCI scale) and the Conscious level-Mobility-Haemodynamics-Oxygenation-Nutrition Index (COMHON). The moving average was used to create a series of three day averages from the complete time-data set. The moving average method was used to analyze data points by creating series of averages of three days subsets of the time-data set. We calculated the efficiency of the method as the product of positive (PPV) and negative predicted values (NPV) for each scale.

RESULTS: The efficiency using the moving average method was: PPV x NPV=0.483×0.907=0.438 (standard deviation=0.059), for EVARUCI Scale, and. PPV x NPV=0.552×0.806=0.445 (standard deviation=0.075) for COMHON Index.

CONCLUSIONS: The efficiency using the moving average method was higher, than the efficiency of other methods previously reported (0.360±0.009 on average). The present study provides a useful procedure for nurses in clinical practice to assess whether a particular patient is protected against the appearance of pressure injury. The instrument should be used focusing on negative predictive value to indicate protection against pressure injury.