Volume 38 Issue 8
Aug.  2022
Turn off MathJax
Article Contents
Huang M,Huang HQ,Xiong AB,et al.Development of a risk assessment scale and test of its validity and reliability for venous thromboembolism in adult burn patients[J].Chin J Burns Wounds,2022,38(8):778-787.DOI: 10.3760/cma.j.cn501120-20210322-00098.
Citation: Huang M,Huang HQ,Xiong AB,et al.Development of a risk assessment scale and test of its validity and reliability for venous thromboembolism in adult burn patients[J].Chin J Burns Wounds,2022,38(8):778-787.DOI: 10.3760/cma.j.cn501120-20210322-00098.

Development of a risk assessment scale and test of its validity and reliability for venous thromboembolism in adult burn patients

doi: 10.3760/cma.j.cn501120-20210322-00098
Funds:

Special Scientific Research Project of Prevention and Treatment of Venous Thromboembolism (Hengrui) of Sichuan Medical Association 2019HR12

More Information
  • Corresponding author: Zheng Silin, Email: 1400223549@qq.com
  • Received Date: 2021-03-22
  •   Objective  To develop a venous thromboembolism (VTE) risk assessment scale for adult burn patients and to test its reliability and validity.  Methods  The scale research method and multi-center cross-sectional survey method were used. Based on the results of literature analysis method and brain-storming method, the letter questionnaire for experts was formulated. Then 27 experts (9 doctors of burn department, 9 vascular surgeons, and 9 nurses) were performed with two rounds of correspondences by Delphi method, and the reliability of the experts was analyzed. The weight of each item was determined by optimal sequence diagram method and expert importance evaluation to form the VTE Risk Assessment Scale for Adult Burn Patients. A total of 223 adult burn inpatients, who were admitted to 5 tier Ⅲ grade A general hospitals including the Affiliated Hospital of Southwest Medical University, West China Hospital of Sichuan University, the Affiliated Hospital of North Sichuan Medical College, Nanchong Central Hospital, and the Second People's Hospital of Yibin City from October 1st 2019 to January 1st 2020, were selected as respondents by convenience sampling method. The first assessment was performed with the VTE Risk Assessment Scale for Adult Burn Patients within 24 hours of admission of patients, and real-time assessment was performed as the patients' condition and treatment changed. The highest value was taken as the result. Correlation coefficient method and critical ratio method were used for item analysis; Cronbach's α coefficient was used to test the internal consistency of scale; content validity index was used to analyze the content validity of the scale, and receiver's operating characteristic (ROC) curve was drawn to test the predictive validity of the scale. Data were statistically analyzed with chi-square test, Pearson correlation analysis, independent sample t test, and Z test.  Results  As four questionnaires in the first round of correspondence were rejected as unqualified, and another 4 experts were selected for the 2 rounds of correspondence. Most of them were aged 41 to 50 years with postgraduate degrees, engaging in the current profession for 11 to 30 years, and all of them had professional titles of associate senior or above. The scale, constructed through literature analysis, group brainstorming, and two rounds of correspondence, includes 3 primary items and 50 secondary items. In the first round of correspondence, the recovery rate of valid questionnaires and the ratio with expert opinions were 85.2% (23/27) and 47.8% (11/23), respectively. In the second round of correspondence, the recovery rate of valid questionnaires and the ratio with expert opinions were 100% (27/27) and 11.1% (3/27), respectively. The average collective authority coefficients of experts were both 0.90 in the 2 rounds of correspondence. The mean values of importance assignment, full score rate, and selection rate above 4 were 4.21, 52.5%, and 77.2%, respectively, in the first round of correspondence, and 4.28, 45.2%, and 85.8%, respectively, in the second round of correspondence. The mean coefficients of variation and the mean value of Kendall's coefficient of harmony for each item were 0.21 and 0.30 in the first round of correspondence, respectively, and 0.16 and 0.36 in the second round of correspondence, respectively. In the first and second rounds of correspondence, the Kendall's coefficients of harmony of 3 primary items (age and underlying diseases, burn injury factors, and burn treatment factors) and total secondary items were statistically significant (with χ2 values of 121.46, 107.09, 116.00, 331.97, 169.97, 152.12, 141.54, and 471.70, P<0.01). The weights of primary items for age and underlying diseases, burn injury factors, and burn treatment factors were 0.04, 0.05, and 0.07, respectively. The weights of secondary items ranged from 0.71 to 0.99, with assigned values of 3 to 6. The total burn area of 223 patients ranged from 1% to 89% total body surface area, and the patients were aged from 19 to 96 years, with the risk assessment score from 0 to 98. Nine patients developed VTE, with a risk assessment score of 41 to 90. The scores of 37 items were significantly positively correlated with the total score of scale (with r values of 0.14 to 0.61, P<0.05 or P<0.01), and the items were retained. There were 36 secondary items with statistically significant differences between the patients in high-score group and low-score group (with Z values of -4.88 to -2.09, t values of -11.63 to -2.09, P<0.05 or P<0.01), and the items were retained. The total Cronbach's α coefficient of scale was 0.88. The total content validity index of scale was 0.95. The optimal threshold of the scale for the diagnosis of VTE was 40, at which the sensitivity was 88.9%, the specificity was 87.4%, the Youden index was 0.87, and the area under the ROC curve was 0.96 (with 95% confidence interval of 0.93 to 0.99, P<0.01).  Conclusions  The age and underlying diseases, burn injury factors, and burn treatment factors are the risk factors for VTE in adult burn patients. The VTE risk assessment scale for adult burn patients developed based on these factors has good reliability and validity, and provide good reference value for clinical VTE risk assessment.

     

  • loading
  • [1]
    邵翔,甄凯元,雷洁萍.2018版中国《肺血栓栓塞症诊治与预防指南》解读之六:静脉血栓栓塞症预防策略[J].中国实用内科杂志,2018,38(11):1027-1029.DOI: 10.19538/j.nk2018110107.
    [2]
    RybarczykMM,SchaferJM,ElmCM,et al.A systematic review of burn injuries in low- and middle-income countries: epidemiology in the WHO-defined African Region[J].Afr J Emerg Med,2017,7(1):30-37.DOI: 10.1016/j.afjem.2017.01.006.
    [3]
    LiQ, BaT, WangLF, et al. Stratification of venous thromboembolism risk in burn patients by Caprini score[J].Burns,2019,45(1):140-145.DOI: 10.1016/j.burns.2018.08.006.
    [4]
    SikoraS,PappA.Venous thromboembolism in burn patients is not prevented by chemoprophylaxis[J].Burns,2017,43(6):1330-1334.DOI: 10.1016/j.burns.2017.03.014.
    [5]
    AlturkiN,AlkahtaniM,DaghistaniM,et al.Incidence and risk factors for deep vein thrombosis among pediatric burn patients[J].Burns,2019,45(3):560-566.DOI: 10.1016/j.burns.2018.09.032.
    [6]
    ShirolSS,KodaganurS,RaoMR,et al.The conundrum of deep vein thrombosis prophylaxis in burns in India and review of literature[J].Indian J Plast Surg,2017,50(3):288-294.DOI: 10.4103/ijps.IJPS_179_15.
    [7]
    GalanisT,KraftWK,MerliGJ.Prophylaxis for deep vein thrombosis and pulmonary embolism in the surgical patient[J].Adv Surg,2011,45:361-390.DOI: 10.1016/j.yasu.2011.05.001.
    [8]
    杨丽,王卫.烧伤患者深静脉血栓的防治与护理[J].医疗装备,2018,31(17):196-198.DOI: 10.3969/j.issn.1002-2376.2018.17.117.
    [9]
    LiuA, MinasianRA, ManiagoE, et al. Venous thromboembolism chemoprophylaxis in burn patients: a literature review and single-institution experience[J]. J Burn Care Res, 2021,42(1):18-22. DOI: 10.1093/jbcr/iraa143.
    [10]
    ChopraV,FallouhN,McGuirkH,et al.Patterns, risk factors and treatment associated with PICC-DVT in hospitalized adults: a nested case-control study[J].Thromb Res,2015,135(5):829-834.DOI: 10.1016/j.thromres.2015.02.012.
    [11]
    TracyLM, CameronPA, SingerY, et al. Venous thromboembolism prophylaxis practice and its association with outcomes in Australia and New Zealand burns patients[J/OL]. Burns Trauma, 2021,9:tkaa044[2021-03-22].https://pubmed.ncbi.nlm.nih.gov/33654696/. DOI: 10.1093/burnst/tkaa044.
    [12]
    ISBI Practice Guidelines Committee, SubcommitteeAdvisory, SubcommitteeSteering. ISBI Practice Guidelines for Burn Care, part 2[J].Burns,2018,44(7):1617-1706.DOI: 10.1016/j.burns.2018.09.012.
    [13]
    GouldMK,GarciaDA,WrenSM,et al.Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):Se227-e277.DOI: 10.1378/chest.11-2297.
    [14]
    董煜廷,徐建萍.Caprini血栓评估表临床使用局限性分析[J].护理学杂志,2020,35(4):104-107.DOI: 10.3870/j.issn.1001-4152.2020.04.104.
    [15]
    黄超文,冯起校.静脉血栓形成的相关危险因素[J].中国循证心血管医学杂志,2010,2(2):115-117,124.DOI: 10.3969/j.issn.1674-4055.2010.02.18.
    [16]
    van der LeeL,HillAM,PatmanS.Expert consensus for respiratory physiotherapy management of mechanically ventilated adults with community-acquired pneumonia: a Delphi study[J].J Eval Clin Pract,2019,25(2):230-243.DOI: 10.1111/jep.13077.
    [17]
    伍琳,孙艳杰.德尔菲法简介及在护理学中的应用现状[J].护理研究,2015,29(10):3599-3601.DOI: 10.3969/j.issn.1009-6493.2015.29.006.
    [18]
    张文华 痛风症候规范化的德尔菲法研究 南京 南京中医药大学 2017

    张文华.痛风症候规范化的德尔菲法研究[D].南京:南京中医药大学,2017.

    [19]
    张毅,汪健健,邓艳红,等.护士人文素养自评量表的研制及信效度检验[J].中华护理杂志,2022,57(9):1120-1128.DOI: 10.3761/j.issn.0254-1769.2022.09.014.
    [20]
    胡琳莉,王秋琴,宋玉磊,等.基于德尔菲法构建中医护理人才分层评价指标体系[J].护理研究,2021,35(1):7-14.DOI: 10.12102/j.issn.1009-6493.2021.01.002.
    [21]
    曹婷婷,芦桂芝,王晓慧,等.基于德尔菲和优序图法构建ICU医院感染风险评价指标体系[J].护理学杂志,2016,31(5):44-47.DOI: 10.3870/j.issn.1001-4152.2016.05.044.
    [22]
    李洪兴,罗庆,张荣,等.肯德尔和谐系数W检验及程序实现[J].中国医院统计,2013,20(3):170-173.DOI: 10.3969/j.issn.1006-5253.2013.03.004.
    [23]
    孙振球.医学统计学[M].3版.北京:人民卫生出版社,2010:407-417.
    [24]
    赵泽华,孙琳,刘云,等.急诊创伤患者低体温管理方案的构建[J].中华护理杂志,2018,53(4):448-453.DOI: 10.3761/j.issn.0254-1769.2018.04.014.
    [25]
    谢煜 基于系统评价与Delphi法构建骨科大手术患者深静脉血栓的护理预防策略研究 南京 南京中医药大学 2017

    谢煜. 基于系统评价与Delphi法构建骨科大手术患者深静脉血栓的护理预防策略研究[D].南京:南京中医药大学,2017.

    [26]
    中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南(第三版)[J].中华普通外科杂志,2017,32(9):807-812.DOI: 10.3760/cma.j.issn.1007-631X.2017.09.032.
    [27]
    MirzaeiN,DehdariT,TaghdisiMH,et al.Development of an instrument based on the theory of planned behavior variables to measure factors influencing Iranian adults' intention to quit waterpipe tobacco smoking[J].Psychol Res Behav Manag,2019,12:901-912.DOI: 10.2147/PRBM.S196417.
    [28]
    李莹,刘婷,苗秀欣,等.痛风影响量表的汉化与信度效度检验[J].中国护理管理,2019,19(10):1472-1477.DOI: 10.3969/j.issn.1672-1756.2019.10.009.
    [29]
    张文芳,郝艳华,田甜.心力衰竭患者口渴困扰量表的汉化及信效度研究[J].中华护理杂志,2019,54(6):957-960.DOI: 10.3761/j.issn.0254-1769.2019.06.032.
    [30]
    颜艳,王彤.医学统计学[M].5版.北京:人民卫生出版社,2020:580-587.
    [31]
    芦鸿雁,宋晓琳,王晓娟,等.中文版护士对老年患者活动能力低下预防性护理评价量表的信效度研究[J].护理学杂志,2017,32(21):76-79.DOI: 10.3870/j.issn.1001-4152.2017.21.076.
    [32]
    张鸿儒,刘宇,余一彤,等.疾病多维度反刍思维量表的汉化及信效度评价[J].护理研究,2020,34(18):3214-3219.DOI: 10.12102/j.issn.1009-6493.2020.18.006.
    [33]
    HarringtonLB,HaganKA,MukamalKJ,et al.Alcohol consumption and the risk of incident pulmonary embolism in US women and men[J].J Thromb Haemost,2018,16(9):1753-1762.DOI: 10.1111/jth.14224.
    [34]
    JohanssonM,JohanssonL,WennbergM,et al.Alcohol consumption and risk of first-time venous thromboembolism in men and women[J].Thromb Haemost,2019,119(6):962-970.DOI: 10.1055/s-0039-1681100.
    [35]
    涂加园,刘云,孙琳,等.创伤患者低体温风险评估量表的编制及信效度检验[J].中华护理杂志,2020,55(12):1813-1818.DOI: 10.3761/j.issn.0254-1769.2020.12.010.
    [36]
    贾秀玲,范静,王志,等.基于德尔菲法构建碳青霉烯类抗菌药物合理应用敏感指标[J].中国现代应用药学,2020,37(20):2549-2554.DOI: 10.13748/j.cnki.issn1007-7693.2020.20.021.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(4)

    Article Metrics

    Article views (167) PDF downloads(34) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return