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Objective To review the risk factors included in pressure ulcer risk assessment scales and construct a theoretical model for identifying the etiological factors of skin ulcers, excluding those of systemic origin (e.g., venous, arterial, and neuropathic). Methods Consensus study with expert panel (Delphi Method) based on a structured review of the literature. A search was conducted of the main databases between 1962 and 2009 with no language limitations. All descriptive or validation studies were included, but the grey literature was excluded. After identifying the risk factors in each scale, they were grouped into risk dimensions as a basis for constructing a new theoretical model. Results Eighty-three risk factors were identified in the 56 scales reviewed, and the risk factors were then classified by the expert panel into 23 risk dimensions. These dimensions were used to construct a new theoretical model (middle-range theory) for chronic wound development that explains the production mechanism of seven types of lesion: moisture, pressure, friction, combined pressure-moisture, combined pressure-friction, multifactorial lesions, and coadjuvant factors. These lesions were generically defined as dependence-related injuries. Conclusions Based on the classification of risk factors from the different scales into risk dimensions, a new middle-range theory was constructed that explains the production mechanism of seven dependence-related lesions considered to date as pressure ulcers. Clinical Relevance The prevention and treatment of these lesions requires a correct diagnosis and differentiation of their cause and management of the risk dimensions involved. The type of lesion also influences the selection of local approach. [ABSTRACT FROM AUTHOR]

Aims: To identify risk assessment scales for pressure ulcers that have been used in critical care units. Determine which of them have been validated according to validity, predictive capacity and reliability criteria, developing, where possible, aggregate indicators. Methods: Systematic review of the clinical literature with meta-analysis. The main international health science databases were searched for prospective studies on the validity and/or predictive capacity of pressure ulcers risk assessment scales published between 1962 and 2009 in any language and with a loss to follow-up of less than 25%. We excluded grey literature, reviews, and retrospective and crosssectional studies. The methodological quality of the studies was assessed according to the guidelines of the Critical Appraisal Skills Programme. The indicators analysed were validity, effect size (RR - relative risk) and reliability. When two or more valid original studies were found, a meta-analysis was conducted using the random effect model followed by a sensitivity analysis. Results: A total of 255 articles were found. These articles identified 16 risk assessment scales designed specifically for ICUs. Twenty-six (26) studies measure the validity of these scales. Only three scales have been validated by more than one study (NM Bienstein, Cubbin-Jackson, Jackson- Cubbin). Four general scales have also been validated in ICUs (Braden, Norton, BM Choi Song-and Waterlow). Waterlow and NM Bienstein are not valid due to their low sensitivity. The Cubbin- Jackson, Jackson-Cubbin and Norton scales present very similar predictive validity data, but have only been tested with very small samples. The Braden scale presents the best test results in ICUs, with adequate parameters and predictive validity. Conclusions: We recommend the use of the Braden Scale for the pressure ulcer risk assessment in critical care units. Other scales, such as the Cubbin- Jackson, Jackson-Cubbin, Norton or BM Choi-Song scales, may be useful but need to be tested in larger numbers of patients. [ABSTRACT FROM AUTHOR]