Skin status for predicting pressure ulcer development: A systematic review and meta-analyses
Section snippets
What is already known about the topic?
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Skin assessments by eye and touch are routinely carried out for pressure ulcer prevention to check for abnormalities (e.g., non-blanchable erythema), and people with such skin abnormalities are often considered to be at a particularly high risk of developing new ulcers.
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Guidelines recommend that nurses should increase the provision of preventive interventions (e.g., specific support surfaces) in the presence of non-blanching erythema.
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Three previous systematic reviews summarising the evidence for
What this paper adds
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This prognostic factor systematic review includes thirteen meta-analyses of data for corresponding skin status descriptors and identifies their prognostic value in pressure ulcer development.
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There is no high-certainty evidence that any of the 15 skin descriptors are strong predictors of the risk of new pressure ulcer development. People with non-blanchable erythema may be more likely to develop new pressure ulcers than those without however this evidence is low certainty.
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High-quality,
Objectives
To assess the independent prognostic value of a variety of skin status descriptors in predicting pressure ulcer development.
Methods
This review was based on recent methods developments in the design and conduct of prognosis systematic reviews proposed by the Cochrane Prognosis Methods Group (Riley et al., 2007). It was registered with PROSPERO (CRD42016042140) and complies with the Meta-analyses Of Observational Studies in Epidemiology statement for its reporting (Stroup et al., 2000).
Search results
We retrieved 6908 records through electronic searching and other resources. Full-text screening of 561 potentially relevant studies led to the inclusion of 41 studies (with 50 publications) (see Fig. 1 Allegretti, 2008; Allman et al., 1995; Anthony et al., 2000, 2003; Baumgarten et al., 2004,2006,2009; Bergquist-Beringer and Gajewski, 2011; Berlowitz et al., 1996,2001a,2001b; Compton et al., 2008; de Groot et al., 2006; de Souza and Santos, 2007; Defloor and Grypdonck, 2005; DeJong et al., 2014
Main findings
We have conducted the first systematic review with meta-analyses to summarise the evidence on the prognostic value of a variety of skin status descriptors that were considered as patient-level factors for predicting pressure ulcer risk. We include 41 studies with 15 skin descriptors. We found that over half of the 41 studies were judged as being at high risk of bias and they were heterogeneous in terms of settings, populations, skin assessment methods, confounders and other adjustment
Conclusions
Low-certainty evidence suggests that more people with non-blanchable erythema might develop a new pressure ulcer than those without non-blanchable erythema. There is very low-certainty evidence on the prognostic effects of other skin status (e.g., current pressure ulcers, a history of pressure ulcers). In contrast with previous reviews, this review uses recently established prognosis research methods to synthesise the evidence for specific skin status descriptors being predictors of future
Acknowledgements
This research was funded by the President’s Doctoral Scholar award of the University of Manchester (CS) and supported by the NIHR Manchester Biomedical Research Centre. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The authors would like to acknowledge the contribution of Ross Atkinson, Maggie Westby, and Gillian Norman who conducted independent screening of search results for eligible studies, as well as Zhenmi Liu
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