Assessing Predictive Validity of Pressure Ulcer Risk Scales- A Systematic Review and Meta-Analysis.
BACKGROUND
The purpose of this study was to present a scientific reason for pressure ulcer risk scales: Cubbin& Jackson modified Braden, Norton, and Waterlow, as a nursing diagnosis tool by utilizing predictive validity of pressure sores.


METHODS
Articles published between 1966 and 2013 from periodicals indexed in the Ovid Medline, Embase, CINAHL, KoreaMed, NDSL, and other databases were selected using the key word "pressure ulcer". QUADAS-II was applied for assessment for internal validity of the diagnostic studies. Selected studies were analyzed using meta-analysis with MetaDisc 1.4.


RESULTS
Seventeen diagnostic studies with high methodological quality, involving 5,185 patients, were included. In the results of the meta-analysis, sROC AUC of Braden, Norton, and Waterflow scale was over 0.7, showing moderate predictive validity, but they have limited interpretation due to significant differences between studies. In addition, Waterlow scale is insufficient as a screening tool owing to low sensitivity compared with other scales.


CONCLUSIONS
The contemporary pressure ulcer risk scale is not suitable for uninform practice on patients under standardized criteria. Therefore, in order to provide more effective nursing care for bedsores, a new or modified pressure ulcer risk scale should be developed upon strength and weaknesses of existing tools.
Dept. of Nursing, College of Medicine, Soonchunhyang University, Cheonan, Korea.
Seong-Hi
SH
Park
Dept. of Nursing, College of Life Science and Nano Technology, Hannam University, Daejeon, Korea.
Hea Shoon
HS
Lee
Meta-analysis; Pressure ulcer; Sensitivity; Specificity