Comparison of two skin examination methods for grade 1 pressure ulcers

The purpose of this study was to find out whether the application of a transparent device for diagnosing grade 1 pressure ulcers influences grade 1 pressure ulcer prevalence rates and the total number of observed grade 1 pressure ulcers.

It is assumed that the accuracy of visual grade 1 pressure ulcer diagnosis is enhanced if a transparent device is used.

Quasi-experimental.

Within a pressure ulcer prevalence study participating institutions were divided into groups at random. Data collecting nurses of the intervention group (n = 4667) applied a transparent disc. Data collecting nurses of the control group (n = 5095) conducted skin inspection using the 'finger-method'. Group comparisons were conducted. Relations between skin assessment methods and grade 1 pressure ulcer prevalence was analysed by logistic regressions.

Both groups were comparable regarding demographic characteristics. Grade 1 pressure ulcer prevalence in the intervention group was 3.9% and 7.1% in the control group (p<0.001). The total number of observed grade 1 pressure ulcers was 282 (intervention group) and 555 (control group). The chance to identify at least one grade 1 pressure ulcer increased when the 'finger method' was used (p<0.001).

The use of a transparent disc influences the grade 1 pressure ulcer prevalence rates and the total number of observed grade 1 pressure ulcers.

Accurate identification of grade 1 pressure ulcers is important, because the development of those skin alterations indicate an urgent need for preventive measures. As the diagnosis of grade 1 pressure ulcers seems to be affected by the observation method, it is unknown which method is the more accurate. A study of diagnostic accuracy is needed to answer this question. It is recommended to report pressure ulcer prevalence rates including and excluding grade 1.