收稿日期: 2024-11-04
网络出版日期: 2025-04-28
基金资助
国家卫生健康委医院管理研究所2024年医疗质量（循证）管理研究项目(YLZLXZ24G098)
Construction and validation of a risk assessment tool for acute skin failure in ICU patients
Received date: 2024-11-04
Online published: 2025-04-28
目的 构建ICU患者急性皮肤衰竭（acute skin failure，ASF）风险评估工具并进行验证，为评估ICU患者ASF发生风险提供科学的评估工具。方法 以风险管理理论为理论基础，结合文献回顾法和德尔菲专家函询，形成初版评估工具。采用便利抽样法，选取2023年6月—7月山东省某三级甲等综合医院ICU的217例患者为调查对象，采用初版评估工具评估患者发生ASF的风险，并进行项目分析和信效度检验；选取2023年8月—2024年2月该院ICU的1 036例患者对评估工具进行预测效度检验，验证评估工具的预测价值。结果 ICU患者ASF评估工具包含6个一级指标，15个二级指标。该评估工具的Cronbach’s α系数为0.757，内容效度指数为0.940。受试者操作特征曲线下面积为0.976（95%CI：0.968~0.985），Kappa系数0.861（P<0.001），灵敏度为92.1%，特异度为95.7%；最佳截断值为12分，总分风险程度分级为低风险（12~15分）、中风险（16~20分）、高风险（21~27分），评分越高，ICU患者发生ASF的风险越高。结论 该研究构建的ICU患者ASF风险评估工具信效度良好，具有较好的灵敏度和实用性，可有效预测ICU患者ASF的发生。
张建 , 王晓萍 , 史绪生 , 薛雪 , 盖玉彪 , 高祀龙 , 郭小靖 , 魏丽丽 . ICU患者急性皮肤衰竭风险评估工具的构建及验证研究[J]. 中华急危重症护理杂志, 2025 , 6(5) : 517 -523 . DOI: 10.3761/j.issn.2096-7446.2025.05.001
Objective To develop and validate a risk assessment tool for acute skin failure in ICU patients，aiming to provide a scientific assessment tool for evaluating the risk of acute skin failure in ICU patients. Methods Based on the theory of risk management，combined with literature review and Delphi expert consultation，an initial assessment tool was formed. Using convenience sampling，217 patients in the ICU of a tertiary general hospital in Shandong Province from June to July 2023 were selected as the research subjects，and item analysis and reliability and validity tests were conducted. A preliminary validation was carried out on 1，036 patients in the ICU of the same hospital from August 2023 to February 2024 to test the predictive value of the assessment tool and verify its predictive value. Results The assessment tool for acute skin failure in ICU patients included 6 first-level indicators and 15 second-level indicators. The Cronbach’s α coefficient of the tool was 0.757，and the content validity index was 0.940. The area under the receiver operating characteristic curve was 0.976（95%CI：0.968~0.985），Kappa coefficient was 0.861（P<0.001）. with a sensitivity of 92.1% and a specificity of 95.7%. The optimal cut-off value was 12 points，and the total score risk level was classified into low risk（12~15 points），medium risk 16~20 points），high risk（21~27 points）. The higher the score，the higher the risk of acute skin failure in ICU patients. Conclusion The risk assessment tool for ICU patients developed in this study has good reliability and validity，and has good sensitivity and practicality，which can effectively predict the occurrence of acute skin failure in ICU patients.
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