Braden Risk Değerlendirme Skalası Yoğun Bakım Ünitesinde Tedavi Gören 3. Düzey Hastalarda Basınç Ülseri Oluşumu Riskini Değerlendirmekte Güvenilir ve Yeterli mi?

Amaç: Basınç ülseri önlenmesinde risk gruplarının saptanarak o hastalara yönelik eylem planı yapılması sorunun çözümüne önemli katkı sağlar. Bu amaçla ülkemizde en yaygın kullanılan ölçek Braden Risk Değerlendirme Skalası'dır (BRDS). Yaptığımız çalışmada yoğun bakım ünitesinde (YBÜ) tedavi gören 3. düzey hastalarda, BRDS'nin risk gruplarını belirlemede geçerliliğini saptamayı amaçladık.Yöntemler: Prospektif, tek merkezli çalışmaya Ocak 2014-Mayıs 2015 tarihleri arasında olası risk faktörleri mümkün olduğunca standardize edilen 206 adet 3. düzey YBÜ hastası dahil edildi. BRDS'ye göre risk grupları belirlenerek rutin klinik protokolleri doğrultusunda takip ve tedavi edilen hastalar taburcu aşamasında basınç ülseri gelişen ve gelişmeyen olarak iki gruba ayrıldı. Grupların demografik bulguları, yatış süresi, bilinç durumu, Apache II skoru, beklenen-gerçekleşen mortaliteleri, albumin düzeyi ve BRDS karşılaştırıldı.Bulgular: Karşılaştırma sonucunda basınç ülseri gelişen hastalarda hasta yaşının, YBÜ'de yatış süresinin, bilinç düzeyinin, albumin düzeyinin basınç ülseri gelişmeyenlere oranla istatistiki anlamlı farklı olduğu saptandı. Ayrıca basınç ülseri saptanan hastaların skorlarıyla saptanmayanların skorları arasında istatistiki anlamlı fark yoktu. Ek olarak elde ettiğimiz verilere göre risk altında olmayan hastaların %7,14'ünde, düşük riskli hastaların %27,8'inde, orta riskli hastaların %29,73'ünde basınç ülseri gelişirken yüksek riskli hastaların sadece %17,72'sinde basınç ülseri gelişti.Sonuç: Verilerin kendi içinde değerlendirildiğinde BRDS'nin riski belirlemede yetersiz kaldığı ve basınç ülseri gelişiminde rol oynayan parametrelerin BRDS'de yeterince temsil edilmediği kanısına varıldı. Diğer parametreleri de yeterince içeren ve ülkemiz hastalarına daha uygun risk belirleme ölçeklerine ya da mevcutların ciddi modifikasyonuna gereksinim olduğu düşünülmektedir.

Is Braden Scale Reliable and Sufficient to Evaluate the Risk of Pressure Ulcer Occurrence in Level 3 Intensive Care Unit Patients?

Objective: To prevent pressure ulcer, detecting risk factors and planning how to act with respect to patients provide to find solution. Thus, Braden Scale is the most common tool that is used in Turkey. This study aimed to measure Braden Scale effectiveness at detecting the risk groups of level 3 intensive care unit patients.Methods: This prospective, single-center study includes 206 level 3 intensive care unit patients whose risk factors were standardized as much as possible in the intensive care unit between January 2014 and May 2015. Routine clinical care was applied to the patients whose risk groups were determined by Braden Scale, and the patients were divided into two groups depending on the presence of a pressure ulcer before discharging from the hospital. Demographic findings, hospitalization duration, mental status, Apache II score, expected/actual mortality, blood albumin levels, and Braden Scale score were compared.Results: Comparison of the groups showed that patients' age, length of stay in intensive care unit, mental status, and blood albumin levels are significantly different between patients with and without pressure ulcers. Furthermore, scores of patients with pressure ulcers were not significantly different from those of patients without pressure ulcers. Data also illustrated that pressure ulcers occurred in no risk patients with the ratio of 7.14%; in low-risk patients with the ratio of 27.8%; in moderate-risk patients with the ratio of 29.73%; in high-risk patients with the ratio of 17.72%.Conclusion: Data evaluation demonstrates that Braden Scale is not effective to detect the risk factors, and parameters related to pressure ulcer development are not sufficiently represented by Braden Scale. Modification of an existing scale or a new risk assessment scale that includes all other risk parameters and that is more suitable for the patients of our country is required.

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