1. Determining Pressure Injury Risk on Admission to Inpatient Spinal Cord Injury Rehabilitation: A Comparison of the FIM, Spinal Cord Injury Pressure Ulcer Scale, and Braden Scale
- Author
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Anthony S. Burns, Marie-Thérèse Laramée, Carol Y. Scovil, Johanne Higgins, Jude J. Delparte, and Heather M. Flett
- Subjects
Male ,Canada ,030506 rehabilitation ,medicine.medical_specialty ,medicine.medical_treatment ,Physical Therapy, Sports Therapy and Rehabilitation ,Logistic regression ,Risk Assessment ,Cohort Studies ,Disability Evaluation ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,medicine ,Humans ,Spinal cord injury ,Spinal Cord Injuries ,Retrospective Studies ,Pressure Ulcer ,Likelihood Functions ,Rehabilitation ,Pressure injury ,business.industry ,Retrospective cohort study ,Odds ratio ,Middle Aged ,medicine.disease ,Hospitalization ,Scale (social sciences) ,Toileting ,Physical therapy ,Female ,0305 other medical science ,business ,human activities ,030217 neurology & neurosurgery - Abstract
Objective Assess the utility of the admission Spinal Cord Injury Pressure Ulcer Scale (SCIPUS), Braden Scale, and the FIM for identifying individuals at risk for developing pressure injury during inpatient spinal cord injury (SCI) rehabilitation. Design Retrospective cohort. Setting Two tertiary rehabilitation centers. Participants Individuals (N=754) participating in inpatient SCI rehabilitation. Interventions Not applicable. Main Outcome Measures Logistic regression analysis was performed to determine the utility of the SCIPUS, Braden Scale, and FIM for identifying individuals at risk for developing pressure injury (PI) during inpatient SCI rehabilitation. Sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, odds ratio, likelihood ratio, and area under the curve (AUC) are reported. Results The SCIPUS total score and its individual items did not demonstrate acceptable accuracy (AUC≥0.7) whereas the Braden Scale (0.73) and the FIM score (0.74) did. Once items were dichotomized into high and low risk categories, 1 Braden item (friction and shear), 5 FIM items (bathing, toileting, bed/chair transfer, tub/shower transfer, toilet transfer), the FIM transfers subscale, FIM Motor subscale, and the FIM instrument as a whole, maintained AUCs ≥0.7 and negative predictive values ≥0.95. The FIM bed/chair transfer score demonstrated the highest likelihood ratio (2.62) and overall was the most promising measure for determining PI risk. Conclusion Study findings suggest that a simple measure of mobility, admission FIM bed/chair transfer score of 1 (total assist), can identify at-risk individuals with greater accuracy than both an SCI specific instrument (SCIPUS) and a PI specific instrument (Braden). The FIM bed/chair transfer score can be readily determined at rehabilitation admission with minimal administrative and clinical burden.
- Published
- 2019