Psychometric Properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for Pressure Ulcer Risk Assessment During Inpatient Rehabilitation

• Published in: Archives of physical medicine and rehabilitation Vol. 96; no. 11; pp. 1980 - 1985
• Main Authors: Delparte, Jude J., MSc, Scovil, Carol Y., PhD, Flett, Heather M., BScPT, MSc, Higgins, Johanne, PhD, Laramée, Marie-Thérèse, PT, MSc, Burns, Anthony S., MD, MSc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2015
• Subjects: Adult; Female; Humans; Incidence; Inpatients; Male; Middle Aged; Physical Medicine and Rehabilitation; Pressure ulcer; Pressure Ulcer - epidemiology; Prospective Studies; Psychometrics - methods; Psychometrics - standards; Rehabilitation; Rehabilitation Centers; Reproducibility of Results; Risk Assessment; Risk Factors; ROC Curve; Sensitivity and specificity; Spinal cord injuries; Spinal Cord Injuries - rehabilitation; research ethics board; PU; Pressure ulcer; LR; IRR; Reproducibility of results; AUC; IRGLM; likelihood ratio; Risk assessment; intraclass correlation coefficient; Institut de réadaptation Gingras-Lindsay-de-Montréal; spinal cord injury; SCIPUS; Sensitivity and specificity; ICC; interrater reliability; area under the curve; SCIPUS-A; REB; acute Spinal Cord Injury Pressure Ulcer Scale; University Health Network, Toronto Rehabilitation Institute; UHN-TRI; SCI; Spinal cord injuries; Rehabilitation; Spinal Cord Injury Pressure Ulcer Scale
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2015.06.020

Abstract Objective To assess the psychometric properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for pressure ulcer (PU) risk assessment during inpatient rehabilitation. Design Prospective cohort. Setting Tertiary rehabilitation centers. Participants Individuals (N=759) participating in inpatient spinal cord injury rehabilitation between January 3, 2012, and April 23, 2014. Interventions Not applicable. Main Outcome Measures Admission SCIPUS scores and the corresponding risk stratification, PU incidence, intraclass correlation coefficient (ICC) for interrater reliability, sensitivity, specificity, and likelihood ratios (LRs). Receiver operating characteristic analysis was performed to calculate the area under the curve (AUC). Results Mean SCIPUS scores were higher for individuals who developed PUs than for those who did not (mean SCIPUS score, 9.8±2.5 vs 8.5±2.6). Interrater reliability was excellent for SCIPUS composite scores (ICC=.91) and very good for risk stratification (ICC=.86). Using the existing cutoff value of ≥6 for “high risk” category, sensitivity and specificity were estimated to be .97 and .12, respectively, with an LR of 1.1. A cutoff value of ≥8 yielded a better balance between sensitivity and specificity (.85 and .38, respectively). The AUC equaled .64 with an LR of 1.4. Results were similar when the analysis was confined to PUs of stage II or greater. Conclusions The psychometric properties of the SCIPUS do not currently support its routine use as a measure of PU risk in individuals with spinal cord injury undergoing inpatient rehabilitation. LRs of <2 indicate that stratification as high risk or very high risk does not substantially increase the likelihood of identifying individuals who develop PUs beyond chance alone. AUCs were also below the desired cutoff value of 0.7.