Goldstone 1982.

Methods	Patients randomised alternately on arrival in A&E to 1 of 2 alternative surfaces. Follow‐up not clear.
Participants	Patients (> 60 y) with femur fracture. (Mean Norton score 13). Groups comparable at baseline for age and Norton score.
Interventions	1. Beaufort bead bed system (includes bead‐filled mattress on A&E trolley; bead‐filled operating table overlay; bead‐filled sacral cushion for operating table; bead‐filled boots to protect heels on operating table (n = 32). 2. Standard supports in A&E, operating theatre, ward (n = 43).
Outcomes	Grading of ulcers not given. Beaufort bead bed system: 16%; Standard surface: 49%. Maximum width of broken skin (mean): Beaufort bead bed system: 6.4 mm; Standard surface: 29.5 mm.
Notes	Patients in the Beaufort bead bed group who were incontinent of urine (numbers not given) were catheterised, however, this did not seem to be the same for the control group. Patients who were removed from the Beaufort bed standard surfaces for any reason not included in analysis. Number of withdrawals unclear; no ITT analysis.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	“Patients...were assigned alternately (from a random start) either to the Beaufort system or to the existing ‘standard’ surfaces as encountered on trolleys, beds, surgical tables etc”.
Allocation concealment (selection bias)	Unclear risk	See above ‐ not reported.
Blinding (performance bias and detection bias) Pressure ulcer incidence	Unclear risk	Not reported.
Incomplete outcome data (attrition bias) All outcomes	High risk	“Patients who were later found to have suffered no fracture, or who requested to be removed from the Beaufort system for any reason, or who died before reaching the post operative ward are excluded from the analysis".
Selective reporting (reporting bias)	Low risk	All pre‐specified outcomes reported.
Free of other bias ‐ were groups similar at baseline regarding the most important prognostic indicators?	Low risk	“The two groups were well matched on a variety of criteria on admission”.
Free of other bias ‐ was the timing of the outcome assessment similar in all groups?	Low risk	No other concerns.