Validation of the interRAI Pressure Ulcer Risk Scale in Acute Care Hospitals.

Abstract

To validate the Pressure Ulcer Risk Scale (PURS) to screen for pressure ulcer (PU) outcomes in the acute hospital setting. Secondary data analysis was undertaken using a combined dataset from three prospective cohort studies. General medical, surgical, and orthopedic wards in 11 hospitals in two states of Australia. Individuals aged 70 and older admitted to the hospital for longer than 48hours from July 2005 to May 2010 (N=1418). Individuals in coronary or intensive care units, palliative care, or transferred out of the ward within 24hours were excluded. Trained nurses used the international Resident Assessment Instrument (interRAI) Acute Care (AC) assessment tool to collect data at admission and discharge. Adverse outcomes were documented on daily ward visits. The PURS was calculated from interRAI items, and its association with PU outcomes was tested using the c-statistic (area under the receiver operator characteristic curve). Complete data were available for 1,371 (96.7%) participants, 85 of whom (6.2%) had a PU at admission. Of the 1,286 without PUs at admission, 42 (3.3%) developed a new PU during their hospital stay. The association between PURS and outcomes had a c-statistic of 0.81 (standard error (SE) 0.02) for prevalent ulcers at admission and 0.70 (SE 0.04) for incidence of new PUs. When derived from the interRAI AC tool, the PURS demonstrated good to strong ability to screen for PU outcome in acute care. Assessment burden is reduced without loss of fidelity by integrating the risk scale into an existing assessment system.