Summary of findings 5. Waterlow pressure ulcer risk assessment compared with Ramstadius pressure ulcer risk assessment for the prevention of pressure ulcers.

Waterlow pressure ulcer risk assessment compared with Ramstadius pressure ulcer risk assessment for the prevention of pressure ulcers
Patient or population: patients at risk of pressure ulcers Setting: hospital setting Intervention: Waterlow pressure ulcer risk assessment Comparison: Ramstadius pressure ulcer risk assessment tool
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
	Ramstadius pressure ulcer risk assessment tool	Waterlow pressure ulcer risk assessment
Pressure ulcer incidence Visual skin assessment Follow‐up: 4 days	Study population		RR 1.41 (0.83 to 2.39)	23 more per 1000 (from 8 fewer to 75 more)	821 (1 study)	⊕⊕⊝⊝ Low1	Risk assessment using the Waterlow risk assessment tool may make little or no difference to pressure ulcer incidence when compared to use of the Ramstadius pressure ulcer risk assessment tool.
	52 per 1000	75 per 1000 (45 to 128)
Severity of new pressure ulcers ‐ Stage 1	44 per 1000	51 per 1000 (28 to 94)	RR 1.16 (0.63 to 2.15)	7 more per 1000 (from 16 fewer to 50 more)	821 (1 study)	⊕⊕⊝⊝ Low1	Risk assessment using the Waterlow risk assessment tool may make little or no difference to pressure ulcer severity (stage 1) when compared to use of the Ramstadius pressure ulcer risk assessment tool.
Severity of new pressure ulcers ‐ Stage 2	10 per 1000	24 per 1000 (10 to 61)	RR 2.49 (0.79 to 7.89)	15 more per 1000 (from 2 fewer to 69 more)	821 (1 study)	⊕⊕⊝⊝ Low1	Risk assessment using the Waterlow risk assessment tool may make little or no difference to pressure ulcer severity (stage 2) when compared to use of the Ramstadius pressure ulcer risk assessment tool.
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.