Risk-assessment tools in the prevention of pressure ulcers

Some screening tools exist for assessing increased risk of the development of pressure ulcers, but none of these tools has undergone actual testing for validity and predictive value. This is important in clinical practice because the combination of high sensitivity and rather low specificity implies that the number of patients at increased risk is overestimated and thus overtreated (i.e., unnecessary preventive measures are taken). Risk scores are usually composed of items considered to influence the development of pressure ulcers. Although for some scoring systems attempts have been made to enhance specificity by changing the cutoff points or the relative value of individual items, good results have not been achieved. The influence that individual items have on the development of pressure ulcers and the impact of this influence on score outcomes has not yet been established. In this study, 65 patients with and 58 patients without pressure ulcers were compared using all of the known risk factors analyzed by multivariate logistic regression. We found that only the Norton, Douglas, and Dutch Consensus Meeting scoring systems appeared to predict the development of pressure ulcers. Also, it appeared that incontinence for urine and the presence of both neurologic disorders and friction forces to the skin effectively predict the development of pressure ulcers. Considering the important implications of this study, a larger study--consisting of several thousand patients--should be performed to assess in more detail the variables currently perceived as risk factors and construct and evaluate a scoring system based on these results.