Predicting pressure ulcers: cases missed using a new clinical prediction rule

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Abstract
Aim.  The aim of this paper is to report a study describing patients with pressure ulcers that were incorrectly classified as ‘not at risk’ by the prediction rule and comparing them with patients who were correctly classified as ‘not at risk’.Background.  Patients admitted to hospital are at risk of developing pressure ulcers. Although the majority of pressure ulcers can be predicted using a recently developed prediction rule, up to 30% of patients with pressure ulcers may still be misclassified.Methods.  Between January 1999 and June 2000 a prospective cohort study was conducted in two large hospitals in the Netherlands. Patients admitted to neurology, internal, surgical, and elder care wards for more than 5 days were included (n = 1229), and were examined weekly. Information on potential prognostic determinants for pressure ulcers mentioned in the literature was recorded. Outcome was defined as occurrence of a pressure ulcer grade 2 or worse during hospital admission.Results.  Patients who developed pressure ulcers experienced more problems with ‘friction and shear’ and underwent surgery more often and longer. Also, they were more often admitted because of malignant conditions.Conclusion.  We found no specific characteristics that clearly distinguished patients with pressure ulcers that were incorrectly classified as ‘not at risk’ by the prediction rule from patients who were correctly classified as ‘not at risk’. It appears difficult to improve further on the prediction of pressure ulcers using available clinical information.