Predictive validity of the INTEGRARE scale in identifying the risk of hospital-acquired pressure ulcers in acute care hospital settings

Abstract

Background: Hospital-acquired pressure ulcers (HAPUs) are prevalent around the world and are an indicator of care quality. Numerous instruments are available to predict their appearance, but few evaluate predictive val idity. No instruments based on Nursing Outcomes Classification indicators have been found, despite these in dicators reflecting the patient’s condition. The aim of the study was to analyse the predictive validity of the INTEGRARE scale in preventing the risk of HAPUs. Methods: A multicentre prospective observational cohort study design was used. 1,004 patients from 11 public hospitals in Andalusia (Spain) were recruited between February 2015 and October 2017. Participants were aged over 18 and had been admitted to medical and surgical units, with a predicted stay exceeding 48 h. Predictive validity was checked using a multivariate logistic regression model and a receiver operating characteristic curve, with development of pressure ulcers during the hospital stay as the dependent variable. Results: The INTEGRARE scale obtained an area under the curve of 0.886 (95% CI = 0.85–0.923). Within the 30- point range, the optimal cut-off value is 23 points with a sensitivity of 80.8% and a specificity of 80%. The odds ratio was 16.86 (95% CI = 8.54–33.28). Among the patient variables, age was significant, while among the hospital variables, the type of unit and the Nurse Staffing Level (NSL) were significant. Conclusions: The INTEGRARE scale has robust predictive validity when patients are admitted to medical and surgical inpatient units. Patients with a higher risk of developing HAPUs are in surgical units, are elderly, and have an NSL exceeding 10.4.