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Lookup NU author(s): Emeritus Professor Senga Bond
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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≥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. © 2006 Elsevier Ltd. All rights reserved.
Author(s): Nixon J, Cranny G, Bond S
Publication type: Article
Publication status: Published
Journal: International Journal of Nursing Studies
Year: 2007
Volume: 44
Issue: 5
Pages: 655-663
ISSN (print): 0020-7489
ISSN (electronic): 1873-491X
Publisher: Pergamon
URL: http://dx.doi.org/10.1016/j.ijnurstu.2006.02.010
DOI: 10.1016/j.ijnurstu.2006.02.010
PubMed id: 16631178
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