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Exploration of pre-surgical risk assessment tools to identify pressure injury risk in cardiac surgical patients Turnbull, Pamela


Background: Cardiac surgical patients are at high risk for developing pressure injuries during their perioperative experience. These injuries may have significant impacts on morbidity, mortality, quality of life and health care system costs. One strategy to prevent pressure injuries is to identify high-risk patients prior to surgery that would allow for the implementation of prevention strategies. The majority of risk assessment tools in use today were developed in acute and long-term care settings and have been found ineffective in surgical populations. New pre-operative tools that are specific to surgical patients are now available. Purpose: The aim of this research study was to explore the relative predictive capabilities of the three risk assessment tools. Methods: This pilot study involved a retrospective chart review conducted at St. Paul’s Hospital in Vancouver, British Columbia. Three risk assessment tools were retrospectively applied in a two arm comparison, to two groups of cardiac surgical patients where one group developed pressure injuries and the other had not. Descriptive statistics and logistic regression were then applied to analyse the data. Findings: Insufficient cases were available to meet the inclusion criteria for the pressure injury arm therefore the focus of the study changed to a pilot study to test the methodology alone. A group of 13 cases were identified (that closely resembled the inclusion criteria) and were used to the pressure injury study arm. A group of 24 cases were identified in the control arm (non-pressure injury) that met the inclusion criteria. The study found that although the Braden Scale Score could statistically predict a pressure injury (p-value 0.04), when compared with the two other scales there was no statistically significant difference in predictive ability. Implications: These results cannot be used to inform clinical practice due to limitations but testing the methodology may help inform future research. Recommendations for future research include diversification of the study sample across multiple sites. Alternatively, if possible performing prospective data collection would help ensure consistency in assessment and data collection, and help in standardizing the pressure injury prevention strategies to compensate for a confounding variable (nursing clinical judgement).

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