Objectives: The Spinal Cord Injury (SCI) Pressure Sore Onset Risk Screening (SCI-PreSORS) instrument is a novel approach for pressure injury (PI) screening. The SCI-PreSORS is for individuals participating in inpatient SCI rehabilitation; and is comprised of four yes/no items (PI history, mobility, transfers, toileting) incorporated into a decision tree. This study prospectively determines test-retest, inter-rater reliability (IRR), and concurrent validity (Braden scale) of the SCI-PreSORS.
Design: Ninety-nine individuals participating in inpatient SCI rehabilitation completed three study visits. Outcomes included the SCI-PreSORS and the Braden scale. Individuals with a Braden scale score ≤ 16 are considered at risk. Study intake was completed within 12 to 21 days of admission (median 16). Retest assessments were completed within four to eight (median 7) days whereas a second rater completed assessments (n=50) within one to six days (median 1). Interim test-retest reliability and IRR analyses were completed using percentage agreement.
Results: Agreement for the level of PI risk (high vs low) at intake was 77%; determined using the Braden scale and the SCI-PreSORS. Test-retest reliability for PI risk was excellent (92%) for the SCI-PreSORS and good (87%) for the Braden scale. Inter-rater reliability was comparable for the SCI-PreSORS (83%) and the Braden scale (85%). For individual items, test-retest reliability ranged from 87% to 95% for the SCI-PreSORS and from 67% to 86% for the Braden scale. IRR for Braden scale items ranged from 43% to 83%. Due to the decision tree format of the SCI-PreSORS, IRR analysis was not possible for individual items.
Conclusions: The SCI-PreSORS demonstrates good IRR and excellent test-retest reliability. Ongoing data collection and pending analyses will provide insight into additional metrics such as Cohen’s kappa, as well as sensitivity and specificity. This will define the ultimate utility of the SCI-PreSORS for PI risk screening during inpatient SCI rehabilitation.
Jude Delparte– Research Associate, KITE (Knowledge Innovation Talent Everywhere) Institute
Jackie Wright– Nurse, Toronto Rehabilitation Institute – University Health Network
Carol McAnuff– Clinical Nurse Specialist, Toronto Rehabilitation Institute - University Health Network
Heather Flett– Advanced Practice Leader, Toronto Rehabilitation Institute - University Health Network
Carol Scovil– Knowledge Mobilization Specialist, Toronto Rehabilitation Institute - University Health Network
Anthony Burns– Affiliate Scientist, KITE (Knowledge Innovation Talent Everywhere) Institute