{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:01:01Z","timestamp":1791259261789,"version":"4.1.0"},"reference-count":39,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["RP-PG-0407-10056"],"award-info":[{"award-number":["RP-PG-0407-10056"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,12,2]]},"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To explore pressure area related pain as a predictor of category \u22652 pressure ulcer (PU) development.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Multicentre prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>UK hospital and community settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants inclusion<\/jats:title><jats:p>Consenting acutely ill patients aged \u226518\u2005years, defined as high risk (Braden bedfast\/chairfast AND completely immobile\/very limited mobility; pressure area related pain or; category 1 PU).<\/jats:p><\/jats:sec><jats:sec><jats:title>Exclusion<\/jats:title><jats:p>Patients too unwell, unable to report pain, 2 or more category \u22652 PUs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Follow-up<\/jats:title><jats:p>Twice weekly for 30\u2005days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary and secondary outcome measures<\/jats:title><jats:p>Development and time to development of one or more category \u22652 PUs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 3819 screened, 1266 were eligible, 634 patients were recruited, 32 lost to follow-up, providing a 602 analysis population. 152 (25.2%) developed one or more category \u22652 PUs. 464 (77.1%) patients reported pressure area related pain on a healthy, altered or category 1 skin site of whom 130 (28.0%) developed a category \u22652 PU compared with 22 (15.9%) of those without pain. Full stepwise variable selection was used throughout the analyses. (1) Multivariable logistic regression model to assess 9 a priori factors: presence of category 1 PU (OR=3.25, 95% CI (2.17 to 4.86), p&lt;0.0001), alterations to intact skin (OR=1.98, 95% CI (1.30 to 3.00), p=0.0014), pressure area related pain (OR=1.56, 95% CI (0.93 to 2.63), p=0.0931). (2) Multivariable logistic regression model to account for overdispersion: presence of category 1 PU (OR=3.20, 95% CI (2.11 to 4.85), p&lt;0.0001), alterations to intact skin (OR=1.90, 95% CI (1.24 to 2.91), p=0.0032), pressure area related pain (OR=1.85, 95% CI (1.07 to 3.20), p=0.0271), pre-existing category 2 PU (OR=2.09, 95% CI (1.35 to 3.23), p=0.0009), presence of chronic wound (OR=1.66, 95% CI (1.06 to 2.62), p=0.0277), Braden activity (p=0.0476). (3) Accelerated failure time model: presence of category 1 PU (AF=2.32, 95% CI (1.73 to 3.12), p&lt;0.0001), pressure area related pain (AF=2.28, 95% CI (1.59 to 3.27), p&lt;0.0001). (4) 2-level random-intercept logistic regression model: skin status which comprised 2 levels (versus healthy skin); alterations to intact skin (OR=4.65, 95% CI (3.01 to 7.18), p&lt;0.0001), presence of category 1 PU (OR=17.30, 95% CI (11.09 to 27.00), p&lt;0.0001) and pressure area related pain (OR=2.25, 95% CI (1.53 to 3.29), p&lt;0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This is the first study to assess pain as a predictor of category \u22652 PU development. In all 4 models, pain emerged as a risk factor associated with an increased probability of category \u22652 PU development.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2016-013623","type":"journal-article","created":{"date-parts":[[2017,1,22]],"date-time":"2017-01-22T01:10:23Z","timestamp":1485047423000},"page":"e013623","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Exploring the role of pain as an early predictor of category 2 pressure ulcers: a prospective cohort study"],"prefix":"10.1136","volume":"7","author":[{"given":"Isabelle L","family":"Smith","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"McGinnis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Briggs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Coleman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Dealey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delia","family":"Muir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E Andrea","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Stevenson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki","family":"Stubbs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyn","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia M","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Nixon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,1,20]]},"reference":[{"key":"2024051611350027000_7.1.e013623.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2009.02307.x"},{"key":"2024051611350027000_7.1.e013623.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2012.11.019"},{"key":"2024051611350027000_7.1.e013623.3","first-page":"30","article-title":"The symptom of pain with pressure ulcers: a review of the literature","volume":"54","author":"Girouard","year":"2008","journal-title":"Ostomy Wound Manage"},{"key":"2024051611350027000_7.1.e013623.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2010.11.016"},{"key":"2024051611350027000_7.1.e013623.5","first-page":"16","article-title":"Pressure ulcer pain: a systematic literature review and national pressure ulcer advisory panel White paper","volume":"55","author":"Pieper","year":"2009","journal-title":"Ostomy Wound Manage"},{"key":"2024051611350027000_7.1.e013623.6","doi-asserted-by":"crossref","unstructured":"Nixon J , Nelson EA , Rutherford C , et al . 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