Non‐blanchable erythema for predicting pressure ulcer development: a systematic review with an individual participant data meta‐analysis

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Abstract

Empirical evidence is uncertain regarding the value of non-blanchable erythema in predicting Stage 2 (or more severe) pressure ulcer incidence. We aimed to investigate whether nonblanchable erythema is an independent prognostic factor for pressure ulcer incidence using individual patient data.
Methods: We performed an electronic database search in February 2017 to identify longitudinal studies that considered non-blanchable erythema for predicting pressure ulcer risk in any population. We collected individual participant data for the included studies, and assessed risk of bias of these studies using the Quality In Prognosis Studies tool. We analysed individual participant data in STATA using mixed-effects logistic regression for investigating the association of our interest. The certainty of evidence from individual participant data analysis was assessed using the Grades of Recommendation Assessment, Development and Evaluation.
Results: Of the thirteen included studies (68,077 participants), we had access to individual participant data from four (n = 3,223) and 11.88% of participants (383/3,223) developed new pressure ulcers of Stage 2 or above within 28 days. Mixed-effects logistic regression showed that participants with nonblanchable erythema had higher odds of developing new pressure ulcers of Stage 2 or above within 28 days of follow-up than those without non-blanchable erythema (multivariable association: n = 2,684; OR 2.72, 95% CI 2.02 to 3.69; tau-squared = 0; moderate-certainty evidence).
Conclusions: The first prognostic factor review with individual-level data analysis in pressure ulcers suggests people with non-blanchable erythema are more likely to develop new pressure ulcers of Stage 2 or above within 28 days than people without non-blanchable erythema. It is important to identify non-blanchable erythema in practice and intervene appropriately to prevent pressure
ulceration.
Original languageEnglish
Pages (from-to)278-286
JournalBritish Journal of Dermatology
Volume182
Issue number2
Early online date23 May 2019
DOIs
Publication statusPublished - 23 May 2019

Keywords

  • Pressure Ulcer
  • non-blanchable erythema,
  • prognostic factor review
  • individual participant data analysis

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