title: Pressure injury risk assessment in intensive care: comparison of inter-rater reliability of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index with three scales.
abstract: OBJECTIVE
  To test the psychometric properties of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index.
  
  
  BACKGROUND
  Pressure injury risk assessment is a crucial aspect in determining the relative risk of patients and the need for preventative intervention. In the intensive care setting there are few risk assessment scales that have been developed specifically for critically ill patients.
  
  
  METHODS
  Instrument development.
  
  
  METHODS
  A convenience sample of 26 intensive care patients was used. Data were collected in December 2012. Five intensive care nurses scored each patient with all four scales. Intraclass correlation coefficients and standard errors of measurement were used to assess inter-rater reliability and agreement of the sum, risk category and item scores. Convergent validity of the COMHON Index was investigated by examining correlations between the sum scores and similar constructs of the scales.
  
  
  RESULTS
  Inter-rater reliability of the COMHON Index was higher than the other scales and strong correlations were found between it and the Braden and Norton scales but not the Waterlow score. Two items common to all scales (mobility; neurological status) demonstrated significant correlations between the COMHON, Braden and Norton scales but not the Waterlow score. One item (nutrition) was significantly correlated between the COMHON and Braden scales.
  
  
  CONCLUSIONS
  Inter-rater reliability and agreement of the COMHON Index were the highest of the four scales, with the Norton and Braden performing similarly and the Waterlow score the least well. The strong and significant associations between the Braden, COMHON and Norton scales suggest they are measuring similar constructs.
authors.affiliation: Australian Catholic University, Brisbane, Queensland, Australia.|The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Fulbrook
authors.affiliation: Intensive Care Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Alissa
authors.initials: A
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015403:Nursing Evaluation Research; D003668:Pressure Ulcer / Q000175:diagnosis* / Q000451:nursing*; D011594:Psychometrics; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000706:statistics & numerical data*; D012307:Risk Factors
keywords: Braden scale; COMHON Index; Norton scale; Waterlow score; intensive care; inter-rater reliability; nursing; pressure injury; pressure ulcer; risk assessment