Shi C, Dumville JC, Cullum N, et al.
International journal of nursing studies. Date of publication 2018 Nov 1;volume 87():14-25.
1. Int J Nurs Stud. 2018 Nov;87:14-25. doi: 10.1016/j.ijnurstu.2018.07.003. Epub
2018 Jul 8.
Skin status for predicting pressure ulcer development: A systematic review and
meta-analyses.
Shi C(1), Dumville JC(2), Cullum N(3).
Author information:
(1)Division of Nursing, Midwifery & Social Work, School of Health Sciences,
Faculty of Biology, Medicine & Health, University of Manchester, Manchester
Academic Health Science Centre, Manchester, M13 9PL, UK. Electronic address:
chunhu.shi@postgrad.manchester.ac.uk.
(2)Division of Nursing, Midwifery & Social Work, School of Health Sciences,
Faculty of Biology, Medicine & Health, University of Manchester, Manchester
Academic Health Science Centre, Manchester, M13 9PL, UK.
(3)Division of Nursing, Midwifery & Social Work, School of Health Sciences,
Faculty of Biology, Medicine & Health, University of Manchester, Manchester
Academic Health Science Centre, Manchester, M13 9PL, UK; Research and Innovation
Division, Manchester University NHS Foundation Trust, Manchester Academic Health
Science Centre, 1st Floor, Nowgen Building, 29 Grafton Street, Manchester, M13
9WU, UK.
BACKGROUND: People with altered skin status are conventionally considered to have
a higher risk of developing new ulcers. However, the evidence underpinning this
potentially prognostic relationship is unclear.
OBJECTIVES: To systematically review the evidence for the prognostic association
of skin status with pressure ulcer risk.
METHODS: We performed a comprehensive electronic database search in February 2017
to identify longitudinal studies that considered skin status in multivariable
analysis for predicting pressure ulcer risk in any population. Study selection
was conducted by two reviewers independently. We collected data on the
characteristics of studies, participants, skin status, and results of
multivariable analyses of skin status-pressure ulcer incidence associations. We
applied the Quality In Prognosis Studies tool to assess risk of bias. We
conducted meta-analyses using STATA where data were available from multivariable
analyses. We used the Grades of Recommendation Assessment, Development and
Evaluation approach to assess the certainty of evidence generated from each
meta-analysis.
RESULTS: We included 41 studies (with 162,299 participants, and 7382 having new
ulcers) that investigated 15 skin descriptors. Participants were predominantly
hospitalised adults and long-term care residents (with a median age of 75.2
years). Studies had a median follow-up duration of 7.5 weeks. 61.0% (25/41) of
studies were judged as being high risk of bias. 53.7% (22/41) of studies had
small sample sizes. Subsequently, the certainty of evidence was rated as low or
very low for all 13 meta-analyses that we conducted though all analyses showed
statistically significant associations of specific skin descriptors-pressure
ulcer incidence. People with non-blanchable erythema may have higher odds of
developing pressure ulcers than those without (Odds Ratio 3.08, 95% Confidence
Interval 2.26-4.20 if pressure ulcer preventive measures were not adjusted in
multivariable analysis; 1.99, 1.76-2.25 if adjusted) (both low-certainty
evidence). The evidence for other skin descriptors was judged as very
low-certainty and their prognostic value is uncertain.
CONCLUSIONS: There is low-certainty evidence that people with non-blanchable
erythema may be more likely to develop new pressure ulcers than those without
non-blanchable erythema. The evidence for the prognostic effects of other skin
descriptors (e.g., history of pressure ulcer) is of very low-certainty. The
findings support regular skin assessment and preventive action being taken in the
presence of non-blanchable erythema. Given the millions at risk of ulceration and
the widely recommended use of skin status as part of risk assessment there is a
need for more, high quality confirmatory studies.
Copyright © 2018 Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.ijnurstu.2018.07.003
PMID: 30015089
