title: Skin alterations of intact skin and risk factors associated with pressure ulcer development in surgical patients: a cohort study.
abstract: BACKGROUND
  The pathology literature suggests three types of pressure ulcer with six possible mechanisms leading to tissue breakdown. A limitation of current evidence is the difficulty in replicating the clinical situation and in determining the point at which a tissue assault becomes irreversible and results in tissue breakdown. In particular clinical observations of alteration in darkly pigmented skin, blanching erythema, non-blanching erythema and non-blanching erythema with other skin changes including induration, oedema, pain, warmth or discolouration have not been assessed in relation to subsequent skin/tissue loss and their pathophysiological and aetiological importance is not fully understood.
  
  
  OBJECTIVE
  To assess the validity of clinical signs of erythema as predictors of pressure ulcer development and identify variables which independently are predictive of Grade 2 pressure ulcer development.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  109 general, vascular and orthopaedic hospital patients, aged over 55 years with an expected length of stay of 5 days were recruited. Of these 97 were pressure ulcer free at baseline and/or had complete follow-up including 59 women and 38 men with a median age of 75 years (range 55-95).
  
  
  METHODS
  Single centre large acute UK NHS hospital.
  
  
  METHODS
  To identify clinical signs of erythema predictive of skin loss, the odds of pressure ulcer development were examined using logistic regression. To identify variables independently predictive of Grade 2 pressure ulcer development logistic regression modeling was undertaken.
  
  
  RESULTS
  There was significantly increased odds of pressure ulcer development associated with non-blanching erythema (7.98, p=0.002) and non-blanching erythema with other skin changes (9.17, p=0.035). Logistic regression modeling identified non-blanching erythema, pre-operative albumin, weight loss, and intra-operative minimum diastolic blood pressure, as independent predictors of Grade > or =2 pressure ulcer development.
  
  
  CONCLUSIONS
  Non-blanching erythema with or without other skin changes is distinct from normal skin/blanching erythema and is associated with subsequent pressure ulcer development.
authors.affiliation: Clinical Trials Research Unit, University of Leeds, 17 Springfield Mount, Leeds LS2 9NG, UK. j.e.nixon@leeds.ac.uk
authors.forename: Jane
authors.initials: J
authors.lastname: Nixon
authors.forename: Gillian
authors.initials: G
authors.lastname: Cranny
authors.forename: Senga
authors.initials: S
authors.lastname: Bond
mesh_terms: D000368:Aged; D004739:England / Q000453:epidemiology; D004890:Erythema / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D005163:Factor Analysis, Statistical; D005260:Female; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D015999:Multivariate Analysis; D009730:Nursing Assessment / Q000379:methods* / Q000592:standards; D015403:Nursing Evaluation Research; D009752:Nutritional Status; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D012307:Risk Factors; D012720:Severity of Illness Index