Validity study of the current risk assessment scale for pressure ulcers in intensive care (EVARUCI)

Pressure ulcers (PU) are the most frequent injuries in critical patients whose management is the responsibility of the nurses. The first step for its prevention is to determine the patients at risk; however the usual risk assessment scales (Norton, Braden, etc.) do not have adequate specificity to do this. Aim. To study the validity of a current risk assessment scale of pressure ulcers in intensive care (EVARUCI). Design. Prospective, descriptive study. Subjects. Adult patients admitted to Intensive Care Unit (ICU) in the Hospital of Fuenlabrada without PU from February, the 1st, 2005 to January, the 31st, 2006. Demographic data were obtained from the admission records. Data on EVARUCI were daily collected and the patients were studied until they developed 1 of 2 outcomes: a) they developed a PU, or b) they left the ICU (death or exit to other nursing ward). Methods. Four validity indexes were used: sensitivity, specificity, positive predictive value and negative predictive value. The area under the curve (AUC) of the receiver operating characteristic (ROC) was also used. These indicators were applied to the mean scores during the entire stay and to the initial and final scores in both groups (PU and NO PU). The SPSS v. 12.0 was used for the statistical analysis. Results. A total of 97 patients were included, 62 of whom finished the study. Eleven patients (17.74%) developed PU. Of these, 57.69% were grade I. The most frequent site was in the sacral area (26.92%) and heels (23.08%). The results of the mean of the scores on the EVARUCI mean, initial and final data were: sensitivity (100%, 100%, 90.91%), specificity (68.63%, 49.02%, 92.16%), positive predictive value (40.74%, 29.73%, 71.43%) and negative predictive value (100%, 100%, 97.2%). AUC of ROC was 0.938, 0.909, 0.952, respectively. Conclusions. The EVARUCI scale is valid to detect patients at risk of development PU in ICU.