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Perineal Assessment Tool (PAT-C)

Validation of a Chinese Language Version and Identification of a Clinically Validated Cut Point Using ROC Curve Analysis

Li, Yi-Min; Lee, Henry Hsin-Chung; Lo, Yu-Ling; Chao, Hui-Lin

Journal of Wound Ostomy & Continence Nursing: March/April 2019 - Volume 46 - Issue 2 - p 150–153
doi: 10.1097/WON.0000000000000510
Continence Care

PURPOSE: The purpose of this study was to evaluate content validity and feasibility of the Chinese language perineal assessment tool (PAT-C), to assess its use in the clinical setting, and establish an optimal cut point for identifying patients at high risk for incontinence-associated dermatitis (IAD).

DESIGN: Psychometric evaluation of existing instrument.

SUBJECTS AND SETTING: The sample comprised 440 patients managed in intensive care units of 3 hospitals across the island of Taiwan and an affiliated home care service. One hundred three nurses practicing throughout Taiwan participated in the workshops in the third phase of the experiment.

METHODS: The content validity of the PAT-C was evaluated by 3 experienced nurses using the content validity index statistic. We calculated a receiver operating characteristics (ROC) curve to determine a cut point of high-risk IAD. The curve was based on assessment of patients from receiving care from the intensive care unit and home care service of Cathay General Hospital (located in Taipei, New Paipei and Hsinchu). Nurse perceptions on the feasibility of PAT-C were assessed using an investigator-developed survey.

RESULTS: Three experienced nurses rated the PAT-C and gave a robust overall content validity index score of 97.22%. The cut point for identifying patients at high risk for developing IAD via ROC curve analysis of 440 patients was 7.5 (sensitivity: 0.85; specificity: 0.79, area under curve: 0.82, P value < .001). One hundred three enrolled nurses attended the workshops and evaluated the feasibility using the PAT-C. Most of the participants considered the PAT-C as necessary (97.90%), 49.7% of participants suggested IAD risk assessment should be implemented by first-line (generalist) nurses, and 40% of participants recommended assessment on a daily basis.

CONCLUSIONS: Study findings indicate robust content validity, and results of the investigator survey of nurse perceptions of the PAT-C indicate the potential for its widespread use in the clinical setting. We found that a cut point score 8 or more indicates a high risk for developing IAD.

Yi-Min Li, Cathay General Hospital, Taipei, Taiwan.

Henry Hsin-Chung Lee, PhD, Hsinchu Cathay General Hospital, Hsinchu, Taiwan; Graduate Institute of Translational and Interdisciplinary Medicine, College of Health Sciences and Technology, National Central University, Taoyuan, Taiwan; and School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.

Yu-Ling Lo, Cathay General Hospital, Taipei, Taiwan.

Hui-Lin Chao, Cathay General Hospital, Taipei, Taiwan.

Correspondence: Hui-Lin Chao, No 280, Jen-Ai Rd, Sec 4, Taipei, Taiwan (

This study was sponsored by Cathay General Hospital Research Funds (CMRI-10102).

The authors declare no conflicts of interest.

© 2019 by the Wound, Ostomy and Continence Nurses Society.