Summary of findings 4. Ramstadius pressure ulcer risk assessment compared with pressure ulcer risk assessment using clinical judgement for the prevention of pressure ulcers.

Ramstadius pressure ulcer risk assessment compared with pressure ulcer risk assessment using clinical judgement for the prevention of pressure ulcers
Patient or population: patients at risk of pressure ulcers Setting: hospital Intervention: Ramstadius pressure ulcer risk assessment Comparison: pressure ulcer risk assessment using clinical judgement
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	Absolute effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Pressure ulcer risk assessment using clinical judgement	Ramstadius pressure ulcer risk assessment
Pressure ulcer incidence Visual skin assessment Follow‐up: 4 days	Study population		RR 0.79 (0.46 to 1.35)	14 fewer per 1000 (from 37 fewer to 24 more)	820 (1 study)	⊕⊕⊝⊝ Low1	Risk assessment using the Ramstadius pressure ulcer risk assessment tool may make little or no difference to pressure ulcer incidence when compared to pressure ulcer risk assessment using clinical judgement.
	68 per 1000	54 per 1000 (31 to 92)
Severity of new pressure ulcers ‐ Stage 1	49 per 1000	44 per 1000 (23 to 82)	RR 0.90 (0.48 to 1.68)	5 fewer per 1000 (from 25 fewer to 33 more)	820 (1 study)	⊕⊕⊝⊝ Low1	Risk assessment using the Ramstadius pressure ulcer risk assessment tool may make little or no difference to pressure ulcer severity (stage1) when compared to pressure ulcer risk assessment using clinical judgement.
Severity of new pressure ulcers ‐ Stage 2	20 per 1000	10 per 1000 (3 to 32)	RR 0.50 (0.15 to 1.65)	10 fewer per 1000 (from 17 fewer to 13 more)	820 (1 study)	⊕⊕⊝⊝ Low1	Risk assessment using the Ramstadius pressure ulcer risk assessment tool may make little or no difference to pressure ulcer severity (stage 2) when compared to pressure ulcer risk assessment using clinical judgement.
Time to ulcer development Pressure ulcer prevalence	Not reported
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

¹Downgraded once for study limitations due to high risk of performance bias. Downgraded once for imprecision due to wide confidence intervals.