Susceptibility to decubitus ulcer formation.

The hypothesis of blood-flow recovery time after pressure relief was prospectively evaluated as a measure of a patient's susceptibility to develop decubitus ulcers. This blood-flow recovery time was measured using the noninvasive pressure-temperature-time (PTT) method, which uses a 10-minute test-pressure stimulus. The blood-flow response after pressure relief was measured by means of skin-temperature measurements. The evaluation was performed in a group of 109 elderly nursing home patients. A pressure-index was used as a measure for the intensity and duration of pressure and shear forces, to which a patient was exposed, to measure a set of external determinants that are independent of the susceptibility. Both the blood-flow recovery time and the pressure-index were found to correlate significantly with the risk to develop decubitus. A conceptualization of the relationship between the risk, on the one hand, and the susceptibility and the external determinants, on the other hand, is presented, assuming independence (orthogonality) of both sets of determinants. Based on this conceptualization, a three-dimensional risk-relationship was constructed. It is concluded that the blood-flow recovery time can be considered to be a measure for the susceptibility. Further, the conceptualization provides valuable insight into the risk-relationships and forms a base for future research with regard to susceptibility.