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Int J Nurs Stud. 2007 Jul;44(5):655-63. Epub 2006 Apr 24.

Skin alterations of intact skin and risk factors associated with pressure ulcer development in surgical patients: a cohort study.

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1
Clinical Trials Research Unit, University of Leeds, 17 Springfield Mount, Leeds LS2 9NG, UK. j.e.nixon@leeds.ac.uk

Abstract

BACKGROUND:

The pathology literature suggests three types of pressure ulcer with six possible mechanisms leading to tissue breakdown. A limitation of current evidence is the difficulty in replicating the clinical situation and in determining the point at which a tissue assault becomes irreversible and results in tissue breakdown. In particular clinical observations of alteration in darkly pigmented skin, blanching erythema, non-blanching erythema and non-blanching erythema with other skin changes including induration, oedema, pain, warmth or discolouration have not been assessed in relation to subsequent skin/tissue loss and their pathophysiological and aetiological importance is not fully understood.

OBJECTIVES:

To assess the validity of clinical signs of erythema as predictors of pressure ulcer development and identify variables which independently are predictive of Grade 2 pressure ulcer development.

DESIGN:

Prospective cohort study.

PARTICIPANTS:

109 general, vascular and orthopaedic hospital patients, aged over 55 years with an expected length of stay of 5 days were recruited. Of these 97 were pressure ulcer free at baseline and/or had complete follow-up including 59 women and 38 men with a median age of 75 years (range 55-95).

SETTING:

Single centre large acute UK NHS hospital.

METHODS:

To identify clinical signs of erythema predictive of skin loss, the odds of pressure ulcer development were examined using logistic regression. To identify variables independently predictive of Grade 2 pressure ulcer development logistic regression modeling was undertaken.

RESULTS:

There was significantly increased odds of pressure ulcer development associated with non-blanching erythema (7.98, p=0.002) and non-blanching erythema with other skin changes (9.17, p=0.035). Logistic regression modeling identified non-blanching erythema, pre-operative albumin, weight loss, and intra-operative minimum diastolic blood pressure, as independent predictors of Grade > or =2 pressure ulcer development.

CONCLUSIONS:

Non-blanching erythema with or without other skin changes is distinct from normal skin/blanching erythema and is associated with subsequent pressure ulcer development.

PMID:
16631178
DOI:
10.1016/j.ijnurstu.2006.02.010
[Indexed for MEDLINE]
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