Skin status for predicting pressure ulcer development: A systematic review and meta-analyses

Area of Science:

• Clinical Medicine
• Prognosis Research
• Dermatology

Background:

• Altered skin status is often considered a risk factor for developing new pressure ulcers.
• However, the evidence supporting this prognostic relationship requires clarification.

Purpose of the Study:

• To systematically review and synthesize evidence on the prognostic association between skin status and pressure ulcer risk.
• To evaluate the certainty of evidence for various skin descriptors in predicting pressure ulcer development.

Main Methods:

• A comprehensive electronic database search was conducted in February 2017.
• Included were longitudinal studies using multivariable analysis for pressure ulcer risk prediction.
• Risk of bias was assessed using the Quality In Prognosis Studies tool, and meta-analyses were performed using STATA.

Main Results:

• 41 studies with 162,299 participants were included, investigating 15 skin descriptors.
• Evidence certainty was low or very low for all 13 meta-analyses, despite statistically significant associations.
• Non-blanchable erythema showed low-certainty evidence of increased odds for pressure ulcer development (OR 3.08 or 1.99).

Conclusions:

• Low-certainty evidence suggests non-blanchable erythema increases pressure ulcer risk.
• Very low-certainty evidence exists for other skin descriptors, such as a history of pressure ulcers.
• Regular skin assessment and preventive actions are recommended for non-blanchable erythema, with a call for high-quality confirmatory studies.