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September 8, 1993

Pressure Ulcer Prevention With Low-Air-Loss Beds

JAMA. 1993;270(10):1197. doi:10.1001/jama.1993.03510100047021

To the Editor.  —The high incidence of new ulcers seen by Inman et al1 was due, in part, to a high incidence of stage I ulcers. Because there is no skin breakdown, diagnosis of stage I ulcers is more variable than diagnosis of ulcers of stages II through IV. How did the investigators control for interrater variability in diagnosis and staging of ulcers, since raters could not be blinded to treatment?About 25% of control patients developed ulcers of stage II or worse (severity score >1). This is a very high rate in patients receiving close attention. Stage II ulcers usually develop from stage I ulcers. Standard treatment of stage I or worse ulcers, other than turning every 2 hours, was not described, and might have been inadequate.Development of ulcers was reported as the number of ulcers that occurred per subject studied. The risk of developing an ulcer