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Pressure sores: risk assessment and prevention
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aims of this thesis were to study the prevalence, incidence, prevention and treatment of pressure sores, to further develop a risk assessment scale, and test the reliability and validity of this scale, to identify risk factors for pressure sore development, and to study skin blood flow in non-blanchable erythema areas as compared to undamaged skin.

Criteria used for pressure sore assessment were persistent discoloration i.e. non-blanchable erythema, epithelial damage, and damage to the full thickness of the skin either without or with a deep cavity. The prevalence study was based on interviews, with 55 registered nurses, about 1173 patients. A Risk Assessment Pressure Sore scale, i.e. the RAPS scale consisting of twelve variables: general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, :fiiction and shear, skin type, bodily constitution, body temperature and serum albumin, was developed. In total 530 patients were assessed with the RAPS scale within 24 hours of admission, thereafter once a week for a maximum of twelve weeks. To estimate equivalence, 10 pairs of nurses assessed a total of 116 patients. A total of 19 blood flow measurements, in 5 patients were performed, using a Laser Doppler perfusion imager.

The prevalence of pressure sores among 1173 patients was 3.75% and the incidence among 530 patients was 11.75%. The most frequently preventive and treatment measures used were related to pressure relief. After the test of internal consistency, two variables were excluded from the RAPS scale, namely bodily constitution and skin type. The Cronbach's alpha coefficient was 0.83. The factor analyses gave three factors, termed mobility, physical condition and nutrition, with a total variance explained of 65.1%. The intraclass correlation between raters was 0.83. Sensitivity was 75% and specificity 70% among patients on medical wards and corresponding values for patients on infection wards were 80% and 69.7%, respectively. In the multiple logistic regression analyses mobility, length of hospitalisation, age, surgical treatment and weight were identified as risk factors for pressure sore development. The blood flow distribution profiles for areas with non-blanchable erythema and those for undamaged skin were found to be different. As the area of non-blanchable erythema decreased, the blood flow distribution profiles gradually became more homogeneous.

In conclusion, pressure sores are still a problem in nursing care. The RAPS scale is a reliable scale for predicting pressure sore development. The validity is especially good for patients on medical wards and infection wards. The results indicate that the scale may be useful in clinical practice. Mobility is a major risk factor and undergoing surgical treatment increases the risk of developing pressure sores. There are differences between blood flow in areas of non-blanchable erythema as compared to undamaged skin. The skin blood flow seems to increase in relation to the size of the non-blanchable erythema.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2003. , 64 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 784
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-27514Local ID: 12170ISBN: 91-7373-542-6 (print)OAI: oai:DiVA.org:liu-27514DiVA: diva2:248066
Public defence
2003-04-29, Berzeliussalen, Hälsouniversitetet, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-09Bibliographically approved
List of papers
1. Pressure sore prevalence within a public health services area
Open this publication in new window or tab >>Pressure sore prevalence within a public health services area
2000 (English)In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 6, no 6, 333-337 p.Article in journal (Refereed) Published
Abstract [en]

Pressure sores are a great problem for patients, staff and society. The aim of this study was to examine the prevalence, treatment and prevention of pressure sores in a public health service area in Sweden. Criteria used for pressure sore assessment were persistent discoloration, epithelial damage and damage to the full thickness of the skin, without or with a cavity. The data were collected during 2 weeks in April 1995 from 1173 inpatients. The pressure-sore prevalence rate was 3.75%; 44 patients had a total of 68 sores. Men were as prone to developing pressure sores as women. The most frequently reported preventive measures were antidecubitus mattresses and turning schedules. Relief from pressure and occlusive dressings were the most common treatment measures. There was no statistical difference in pressure-sore prevalence when compared with a similar study from 1980. Patients were, however, older in 1995.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24810 (URN)10.1046/j.1440-172x.2000.00236.x (DOI)7079 (Local ID)7079 (Archive number)7079 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
2. A risk assessment scale for the prediction of pressure sore development: reliability and validity
Open this publication in new window or tab >>A risk assessment scale for the prediction of pressure sore development: reliability and validity
2002 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 38, no 2, 190-199 p.Article in journal (Refereed) Published
Abstract [en]

Background. The ability to assess the risk of a patient developing pressure sores is a major issue in pressure sore prevention. Risk assessment scales should be valid, reliable and easy to use in clinical practice.

Aim.  To develop further a risk assessment scale, for predicting pressure sore development and, in addition, to present the validity and reliability of this scale.

Methods. The risk assessment pressure sore (RAPS) scale, includes 12 variables, five from the re-modified Norton scale, three from the Braden scale and three from other research results. Five hundred and thirty patients without pressure sores on admission were included in the study and assessed over a maximum period of 12 weeks. Internal consistency was examined by item analysis and equivalence by interrater reliability. To estimate equivalence, 10 pairs of nurses assessed a total of 116 patients. The underlying dimensions of the scale were examined by factor analysis. The predictive validity was examined by determination of sensitivity, specificity and predictive value.

Results.  Two variables were excluded as a result of low item–item and item–total correlations. The average percentage of agreement and the intraclass correlation between raters were 70% and 0·83, respectively. The factor analysis gave three factors, with a total variance explained of 65·1%. Sensitivity, specificity and predictive value were high among patients at medical and infection wards.

Conclusions.  The RAPS scale is a reliable scale for predicting pressure sore development. The validity is especially good for patients undergoing treatment in medical wards and wards for infectious diseases. This indicates that the RAPS scale may be useful in clinical practice for these groups of patients. For patients undergoing surgical treatment, further analysis will be performed.

Keyword
pressure sore, risk assessment, prevention, validity, reliability, instrument development
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24809 (URN)10.1046/j.1365-2648.2002.02163.x (DOI)7076 (Local ID)7076 (Archive number)7076 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
3. Immobility – a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study
Open this publication in new window or tab >>Immobility – a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study
2004 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 18, no 1, 57-64 p.Article in journal (Refereed) Published
Abstract [en]

Objective : To identify risk factors associated with pressure ulcer development among adult hospitalized medical and surgical patients.

Design : A prospective comparative study including 530 adult patients from medical and surgical wards. Registered Nurses made the data collection on admission and once a week for up to 12 weeks. The risk assessment scale used was the Risk Assessment Pressure Sore (RAPS) scale, including the following variables; general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, friction and shear, body temperature and serum albumin.

Results : Sixty-two (11.7%) patients developed 85 pressure ulcers. The most common pressure ulcer was that of nonblanchable erythema. Patients who developed pressure ulcers were significantly older, hospitalized for a longer time, had lower scores on the total RAPS scale, had lower weight and lower diastolic blood pressure than nonpressure ulcer patients did. In the multiple logistic regression analyses using variables included in the RAPS scale immobility emerged as a strong risk factor. When adding remaining significant variables in the analyses, mobility, time of hospitalization, age, surgical treatment and weight were found to be risk factors for pressure ulcer development.

Conclusion : It is confirmed that immobility is a risk factor of major importance for pressure ulcer development among adult hospitalized patients. The results also indicate that the RAPS scale may be useful for prediction of pressure ulcer development in clinical practice.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-22027 (URN)10.1046/j.0283-9318.2003.00250.x (DOI)1063 (Local ID)1063 (Archive number)1063 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
4. Altered skin blood perfusion in areas with non blanchable erythema: an explorative study
Open this publication in new window or tab >>Altered skin blood perfusion in areas with non blanchable erythema: an explorative study
2006 (English)In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 3, no 3, 215-223 p.Article in journal (Refereed) Published
Abstract [en]

Non blanchable erythema, i.e. stage I pressure ulcer, is common in patients in acute and geriatric care and in nursing homes. Research has shown that this type of lesions is prone to develop into more severe pressure ulcers. The peripheral skin blood perfusion is of major importance for the development of pressure ulcers. The aim of this study was to explore the peripheral skin blood perfusion over time, in areas with non blanchable erythema and in corresponding undamaged areas on the opposite side of the body. A total of 19 measurements were performed, over time, using a laser Doppler perfusion imager. The blood flow distribution profiles over areas with non blanchable erythema and undamaged skin were found to be different. As the area of the non blanchable erythema decreased, the blood perfusion distribution profiles gradually became more heterogeneous; an area of high blood perfusion in the centre of the lesions was seen and the perfusion successively decreased closer to the edge. These results indicate that there are differences in blood perfusion between skin areas of non blanchable erythema and undamaged skin. The results also indicate that the visible redness in areas with non blanchable erythema is related to altered blood perfusion. The skin blood perfusion also seems to increase in relation to the size of the non blanchable erythema.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-34928 (URN)10.1111/j.1742-481X.2006.00238.x (DOI)24111 (Local ID)24111 (Archive number)24111 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved

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