[Use of risk scales for decubitus ulcers as screening instruments--A systematic review of external evidence].
BACKGROUND
Reports on the preventive effects of scales to measure the risk of decubitus ulcer development of patients in various care settings have been inconsistent. The value of the different tools as screening instruments for risk factors as one step of a screening program has not yet been evaluated.


OBJECTIVE
To evaluate the prognostic validity of scales measuring the risk of decubitus ulcer development.


METHODS
Studies published in English or German and reporting trials of validity and reliability of scales measuring the risk of decubitus ulcer of patients in any care setting were identified through searches of Medline and CINAHL, Carelit and Heklinet (1981-2000). Reference lists of earlier reviews were checked.


METHODS
257 abstracts were screened; 43 publications were assessed initially, 24 publications were analysed after exclusion criteria have been applied.


METHODS
Abstracts were screened and data on study objective, scale, cut-off, follow-up, population, setting, sensitivity and specificity, trial quality including blinding, reference standard and outcome measurement were assessed.


RESULTS
24 studies analysed five instruments. Due to heterogeneity in study design, methodological quality and outcome assessment pooling of data was not feasible. Only data on the Braden Scale allowed the calculation of likelihood ratios for each point of the scale. Likelihood ratios for the Braden Scale were moderate [LR+ 0.3-7.7 (Cut-off 16)], and fair for the Norton Scale [LR+ 1.4-2.8 (Cut-off 14)].


CONCLUSIONS
The tools investigated as instruments of primary prevention of decubitus ulcers show that their test performance is inadequate. Thus, they are unlikely to be effective as screening instruments for any institutionalised patient group and care setting.
Schlömer
Gabriele
G
Wissenschaftliche Mitarbeiterin, Universität Hamburg. Gabi_Schloemer@uni-hamburg.de
D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D011785:Quality Assurance, Health Care; D012307:Risk Factors