title: Non-blanchable erythema as an indicator for the need for pressure ulcer prevention: a randomized-controlled trial.
abstract: OBJECTIVE
  To evaluate whether postponing preventive measures until non-blanchable erythema appears will actually lead to an increase in incidence of pressure ulcers (grades 2-4) when compared with the standard risk assessment method.
  
  
  BACKGROUND
  To distinguish patients at risk for pressure ulcers from those not at risk, risk assessment scales are recommended. These scales have limited predictive validity. The prevention of further deterioration of non-blanchable erythema (grade 1 pressure ulcer) instead of the standard way of assigning prevention could be a possible new approach.
  
  
  METHODS
  Randomized-controlled trial.
  
  
  METHODS
  Patients admitted to surgical, internal or geriatric wards (n = 1617) were included. They were randomly assigned to an experimental and a control group. In the experimental group (n = 826), prevention was started when non-blanchable erythema appeared, in the control group (n = 791) when the Braden score was <17 or when non-blanchable erythema appeared. In both groups, patients received identical prevention, either by using a polyethylene-urethane mattress in combination with turning every four hours or by using an alternating pressure air mattress. Pressure points were observed daily and classified according to the four grades of the European Pressure Ulcer Advisory Panel. The Braden scale was scored every three days.
  
  
  RESULTS
  In the experimental group, 16% of patients received preventive measures, in the control group 32%. The pressure ulcer incidence (grades 2-4) was not significantly different between the experimental (6.8%) and control group (6.7%).
  
  
  CONCLUSIONS
  Significantly fewer patients need preventive measures when prevention is postponed until non-blanchable erythema appears and those patients did not develop more pressure ulcers than patients who received prevention based on the standard risk assessment method.
  
  
  CONCLUSIONS
  Using the appearance of non-blanchable erythema to allocate preventive measures leads to a considerable reduction of patients in need of prevention without resulting in an increase in pressure ulcers.
authors.affiliation: Nursing Science, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. katrien.vanderwee@ugent.be
authors.forename: Katrien
authors.initials: K
authors.lastname: Vanderwee
authors.forename: Maria
authors.initials: M
authors.lastname: Grypdonck
authors.forename: Tom
authors.initials: T
authors.lastname: Defloor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001510:Bed Rest / Q000009:adverse effects / Q000379:methods / Q000451:nursing; D001513:Beds / Q000706:statistics & numerical data; D001530:Belgium / Q000453:epidemiology; D004890:Erythema / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D020380:Needs Assessment; D009730:Nursing Assessment / Q000458:organization & administration*; D015403:Nursing Evaluation Research; D010173:Palpation / Q000451:nursing; D010808:Physical Examination / Q000451:nursing; D011237:Predictive Value of Tests; D003668:Pressure Ulcer / Q000145:classification / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011322:Primary Prevention / Q000379:methods; D018570:Risk Assessment / Q000458:organization & administration*; D012720:Severity of Illness Index