Pressure ulcer/injury classification today: An international perspective

Kottner, Jan; Cuddigan, Janet; Carville, Keryln; Balzer, Katrin; Berlowitz, Dan R.; Law, Susan; Litchford, Mary Demarest; Mitchell, Pamela H.; Moore, Zena; Pittman, Joyce; Sigaudo‐Roussel, Dominique; Yee, Chang Yee; Haesler, Emily

doi:10.1016/j.jtv.2020.04.003

Cited by 83 publications

(76 citation statements)

References 56 publications

(79 reference statements)

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“…Fundamental properties of all clinical and instrumental measurements in clinical practice and research are reliability quantifying the relative measurement error and agreement quantifying the absolute measurement error 24,25 . Evidence about both types of measurement errors is important, because they directly affect the power of statistical tests of between and within group comparisons and the usefulness of the measurements for clinical decision‐making 26,27 …”

Section: Introductionmentioning

confidence: 99%

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Reliability and agreement of instrumental skin barrier measurements in clinical pressure ulcer prevention research

Kottner

Blume-Peytavi

2021

International Wound Journal

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In skin and wound research the instrumental measurement of skin function is established. Despite the widespread use, empirical evidence about measurement errors is widely lacking. The aim of this study was to measure reliability and agreement of skin temperature, transepidermal water loss, epidermal hydration, and erythema at the heel and sacral skin. Four experienced researchers performed skin measurements in 15 subjects. Lowest reliability was observed for transepidermal water loss at the sacral skin (ICC (1) 0.46 (95% CI 0.00‐0.78)) and highest for skin temperature at the heel skin (ICC (1) 0.99 (95% CI 0.99‐1.00)). Lowest Standard Errors of Measurement were calculated for skin temperature measurements at the heels (0.11°C) and highest for erythema measurements at the sacral skin (26.7 arbitrary units). There was a clear association between variability of estimates and reliability coefficients. Single measurements of skin temperature, stratum corneum, and epidermal hydration at the sacral and heel skin areas can be used in clinical research and practice. Means of at least two measurements should be used for estimating transepidermal water loss and erythema. Evidence is needed to inform researchers about relative and absolute measurement errors of commonly applied instruments and measurements in skin and wound research.

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Section: Introductionmentioning

confidence: 99%

“… 24 , 25 Evidence about both types of measurement errors is important, because they directly affect the power of statistical tests of between and within group comparisons and the usefulness of the measurements for clinical decision‐making. 26 , 27 …”

Section: Introductionmentioning

confidence: 99%

Reliability and agreement of instrumental skin barrier measurements in clinical pressure ulcer prevention research

Kottner

Blume-Peytavi

2021

International Wound Journal

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“…In 2016, the National Pressure Ulcer Advisory Panel (NPUAP) replaced the word "pressure ulcer" to "pressure injury" to elucidate the injury that can also happen in an intact skin. 1,3 Pressure injury has become a significant health issue because of its high cost of treatment, debilitating effect on the patients, and the high recurrence rate despite the preventive measures and treatment. 4,5,6 Pressure injury affects 2.5 million individuals resulting in 60,000 deaths in the US and impacts 700,000 individuals with 29,000 deaths in the UK.…”

Section: Introductionmentioning

confidence: 99%

Keystone Flap for Reconstruction of Sacral and Ischial Pressure Injury

Tunjung

Putri

2021

J Plast Rekons

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Introduction: Reconstruction of sacral and ischial pressure injury offers great challenges due to its high complication and recurrence rate. Providing durable tissue coverage with minimal donor site morbidity is paramount while ensuring fast operative time for the patients who often possess multiple comorbidities. This study aims to present cases of sacral and ischial pressure injury reconstruction using a keystone flap. Method: A retrospective study was performed by reviewing data from fifteen patients with a sacral and ischial pressure injury who underwent reconstruction using various types of keystone flaps in our center between 2019 and 2020. Results: The patients’ age ranged from 10 to 83 years old (average, 40.5 years old). The average wound dimensions were 9.4 ± 3.1 cm x 6.5 ± 2.7 cm and the mean area of the defects was 52.3 ± 35.7 cm2, with the largest defect was 15 x 12 cm (141.3 cm2). Mean operative time was 140 ± 24.5 minutes with nine wounds were reconstructed using type IV keystone flap (60%) and six patients using type IIA (40%). Postoperative complications occurred in three patients (20%). Other patients resulted in uneventful complete healing. Conclusion: The keystone flap is reliable, simple, has a fast technique, and minimal donor site morbidity to cover the defects of sacral and ischial pressure injury. Performing thorough debridement, choosing the right type of keystone flap, elevating the flap adequately to allow mobilization, preserving perforator “hotspots”, and suturing of the flap without tension are keys to achieve satisfactory results.

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“…The current definition of PI states that these are areas of localised damage to the skin and the underlying soft tissue, especially in bony prominences or areas in contact with clinical devices. The forces involved in producing the damage are intense pressure or pressure combined with shear [1]. Currently, it is recommended to systematically use one of the classification systems proposed for staging the PI, from the Stage 1 (non-blanchable erythema) to Stage 4 (full thickness of the skin ulcer) [2].…”

Section: Introductionmentioning

confidence: 99%

Attitudes of Spanish Nurses towards Pressure Injury Prevention and Psychometric Characteristics of the Spanish Version of the APuP Instrument

López-Franco

Parra-Anguita

Comino-Sanz

et al. 2020

IJERPH

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The prevention of pressure injuries in hospitalised patients is a critical point of care related to patient safety. Nurses play a key role in pressure injury (PI) prevention, making it important to assess not only their knowledge but also their attitude towards prevention. The main purpose of this study was to translate into Spanish and evaluate the psychometric properties of the Attitude towards Pressure ulcer Prevention instrument (APuP); a secondary aim was to explore the associations of attitude with other factors. A Spanish version was developed through a translation and back-translation procedure. The validation study was conducted on a sample of 438 nursing professionals from four public hospitals in Spain. The analysis includes internal consistency, confirmatory factorial analysis, and construct validity in known groups. The 12-item Spanish version of the APuP fit well in the 5-factor model, with a Cronbach’s alpha of 0.7. The mean APuP score was 39.98, which means a positive attitude. Registered nurses have a slightly better attitude than Assistant nurses. A moderate correlation (R = 0.32) between knowledge and attitude for the prevention of PI was found. As concluded, the Spanish version of the APuP questionnaire is a valid, reliable and useful tool to measure the attitude toward PI prevention in Spanish-speaking contexts. This version has 12 items grouped into 5 factors, and its psychometric properties are similar to those of the original instrument.

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Pressure ulcer/injury classification today: An international perspective

Cited by 83 publications

References 56 publications

Reliability and agreement of instrumental skin barrier measurements in clinical pressure ulcer prevention research

Reliability and agreement of instrumental skin barrier measurements in clinical pressure ulcer prevention research

Keystone Flap for Reconstruction of Sacral and Ischial Pressure Injury

Attitudes of Spanish Nurses towards Pressure Injury Prevention and Psychometric Characteristics of the Spanish Version of the APuP Instrument

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