Relevance of the diagnosis 'stage 1 pressure ulcer': an empirical study ofthe clinical course of stage 1 ulcers in acute care and long-term care hospital populations

Stage 1 pressure ulcers are difficult to diagnose. Several prevalence studi es have shown that almost half of the pressure ulcers identified are stage 1. The present study investigated the importance of stage 1. The following research questions were formulated: Is there a difference between the preva lence of stage 1 pressure ulcers identified in the institutions participati ng in the present study and that found in the other institutions participat ing in the Dutch National Prevalence Survey? What percentage of stage 1 pre ssure ulcers are reversible within a few hours? What is the clinical course of stage 1 pressure ulcers? Which patient characteristics and preventive i nterventions are related to the clinical course of stage 1? The study used a prospective, descriptive and comparative design. All patients of six long-term care hospitals and six acute care hospitals i n whom stage 1 pressure ulcers were identified during the 1999 National Pre valence Survey in the Netherlands were followed for 1 week (acute care hosp itals; n = 68 patients) or 2 weeks (long-term care hospitals; n = 115 patie nts). The patients were reassessed using the questionnaire developed for the Nati onal Prevalence Survey (patient characteristics, assessment of risk of pres sure ulcers, characteristics of the pressure ulcers and use of preventive m ethods) on the same day as the national survey itself, and again after 3 da ys, after 7 days and after 14 days (only long-term care hospitals). The results showed fewer stage 1 pressure ulcers in the institutions partic ipating in the present study than in the National Prevalence Survey, the di fference being almost 50%. The first reassessment found the prevalence of s tage 1 to be further reduced by an average of almost 50%, a reduction which was greater for the long-term care hospitals than for the acute care hospi tals. However, some of the ulcers that had disappeared reappeared in subseq uent reassessments. In the long-term care hospitals, 8.7% of the stage 1 pressure ulcers deteri orated to a higher stage, vs. 22.19,6 in acute care hospitals. No significant patient characteristics were found to affect the course of s tage 1, except that women in acute care hospitals more often had a stage 1 pressure ulcer at the first reassessment than men. In general, patients whose stage 1 ulcer deteriorated were undergoing more preventive interventions; not all differences were significant. We conclude that, although stage 1 is reversible in most cases, it can be i nterpreted as an important warning sign for nurses and patients to act. If no adequate interventions are applied, the pressure ulcer may deteriorate.