Wynn, MO, Goldstone, L, Gupta, R, Allport, J and Fraser, RDJ (2024) Improving pressure injury risk assessment using real-world data from skilled nursing facilities: A cohort study. International Wound Journal, 21 (7). ISSN 1742-4801

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Abstract

This study aimed to improve the predictive accuracy of the Braden assessment for pressure injury risk in skilled nursing facilities (SNFs) by incorporating real-world data and training a survival model. A comprehensive analysis of 126 384 SNF stays and 62 253 in-house pressure injuries was conducted using a large calibrated wound database. This study employed a time-varying Cox Proportional Hazards model, focusing on variations in Braden scores, demographic data and the history of pressure injuries. Feature selection was executed through a forward-backward process to identify significant predictive factors. The study found that sensory and moisture Braden subscores were minimally contributive and were consequently discarded. The most significant predictors of increased pressure injury risk were identified as a recent (within 21 days) decrease in Braden score, low subscores in nutrition, friction and activity, and a history of pressure injuries. The model demonstrated a 10.4% increase in predictive accuracy compared with traditional Braden scores, indicating a significant improvement. The study suggests that disaggregating Braden scores and incorporating detailed wound histories and demographic data can substantially enhance the accuracy of pressure injury risk assessments in SNFs. This approach aligns with the evolving trend towards more personalized and detailed patient care. These findings propose a new direction in pressure injury risk assessment, potentially leading to more effective and individualized care strategies in SNFs. The study highlights the value of large-scale data in wound care, suggesting its potential to enhance quantitative approaches for pressure injury risk assessment and supporting more accurate, data-driven clinical decision-making.

Item Type:	Article
Uncontrolled Keywords:	Humans; Proportional Hazards Models; Risk Assessment; Risk Factors; Cohort Studies; Aged; Aged, 80 and over; Middle Aged; Skilled Nursing Facilities; Pressure Ulcer; Female; Male; Braden; assessment; pressure injury; risk; survival model; time‐series; Humans; Skilled Nursing Facilities; Pressure Ulcer; Risk Assessment; Male; Female; Aged; Cohort Studies; Aged, 80 and over; Middle Aged; Risk Factors; Proportional Hazards Models; 1103 Clinical Sciences; 1110 Nursing; Dermatology & Venereal Diseases
Subjects:	R Medicine > RT Nursing
Divisions:	Nursing and Advanced Practice
Publisher:	Wiley
SWORD Depositor:	A Symplectic
Date Deposited:	07 Oct 2024 15:27
Last Modified:	07 Oct 2024 15:30
DOI or ID number:	10.1111/iwj.70000
URI:	https://researchonline.ljmu.ac.uk/id/eprint/24428

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