A clinical study of four risk assessment scales in predicting the risk of intraoperative acquired pressure injuries for spinal surgery patients in the prone position

MA Li-na; XU Qi; LIANG Shan-shan; WANG Xin; XU Fei

doi:10.3969/j.issn.2095-252X.2025.01.012

Abstract：Objective To assess the accuracy of the Braden,Waterlow,Munro,and Scott Triggers scale for predicting the risk of intraoperatively acquired pressure injury (IAPI) in patients undergoing spinal surgery in the prone position. Methods 164 patients undergoing spinal surgery in the prone position between June 2021 and June 2024 at our institution were selected. The risk of IAPI was assessed 1 day preoperatively using the Braden,Waterlow,Munro and Scott Triggers scale. The presence of a PI within 3 days postoperatively was diagnosed as IAPI. Internal consistency and correlation among scales were analyzed using the Bland-Altman and Pearson method. Receiver operating characteristic (ROC) curves and consistency tests were used to assess the accuracy and consistency of the scale assessment results. The Braden,Waterlow,Munro,and Scott Triggers scales were assessed for their association with IAPI risk by multifactor logistic regression modeling. Results The incidence of IAPI was 23.1％ (38/164) in 164 patients. Waterlow,Munro and Scott Triggers scale scores were higher in patients with IAPI than in patients without IAPI (P<0.05),and Braden was lower than in patients without IAPI (P<0.05). The Braden and Waterlow scale correlation coefficient r=-0.828 (P<0.001),goodness of fit r2=0.155;Braden and Munro scale correlation coefficient r=-0.677 (P<0.001),goodness of fit r2=0.252;Braden and Scott Triggers scale correlation coefficient r=-0.160 (P<0.001),goodness of fit superiority r2=0.143;Waterlow and Munro scale correlation coefficient r=0.420 (P<0.001),goodness of fit r2=0.429;Waterlow and Scott Triggers scale correlation coefficient r=0.146 (P<0.001),goodness of fit r2=0.524;Munro and Scott Triggers scale correlation coefficient r=0.172 (P<0.001),goodness of fit r2=0.301. ROC curve analysis showed that the area under the curve (AUC) for diagnosing the risk of IAPI on the Braden,Waterlow,Munro,and Scott Triggers scales were 0.719 (0.643-0.786),0.721 (0.645-0.788),0.887 (0.829-0.931),and 0.825 (0.758-0.880),with optimal cutoff values of ≤ 12,>14,>9 and>1 points,respectively. Kappa values between high risk of IAPI assessed by Braden ≤ 12 points,Waterlow>14 points,Munro>9 points,and Scott Triggers>1 point,and true positive results were 0.524,0.361,0.722,and 0.704,respectively (P<0.05). Multifactorial logistic regression analysis showed that Munro and Scott Triggers scales were independent risk factors for the risk of IAPI in patients undergoing spinal surgery in the prone position. Conclusions It is recommended that the Munro scale can be used to assess the risk of IAPI in patients undergoing spinal surgery in the prone position. Patients with a score>9 can be categorized as being at a higher risk,and more aggressive preventive measures can be implemented.