Pressure ulcers: treatment

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

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General background

Pressure ulcers are frequently preventable but may result in increased length of hospital stay and contribute to premature death. The prevalence of pressure ulcers in hospital is about 13% to 14%. Incidence is highest in adult intensive care and general cardiac units. People with spinal cord injuries have a pressure ulcer prevalence of 20% to 30% during the first 5 years after initial injury.

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Focus of the review

High-quality evidence of management strategies of pressure ulcers is limited, and frequently treatments are based on expert opinion and consensus. This overview is an evaluation of the most up to date, best designed studies available on pressure ulcer management strategies.

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Comments on evidence

Well-designed studies on treatment of pressure ulcers are limited. We evaluated interventions for which they were available.

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Search and appraisal summary

The update literature search for this review was carried out from the date of the last search, June 2010, to January 2014. A back search from 1966 was performed for the new options added to the scope at this update. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. Searching of electronic databases retrieved 307 studies. After deduplication and removal of conference abstracts, 203 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 163 studies and the further review of 40 full publications. Of the 40 full articles evaluated, seven systematic reviews and two RCTs were added at this update.

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Substantive changes at this update

Air-fluidised support Two systematic reviews added.[9][10]Categorisation unchanged (likely to be beneficial).

Alternating-pressure surfaces Two systematic reviews added.[9][10] Categorisation unchanged (unknown effectiveness).

Dressings (hydrocolloid and non-hydrocolloid) versus each other One systematic review added.[10] Categorisation unchanged (unknown effectiveness).

Electrotherapy Two systematic reviews added[10][18] and one subsequent RCT[19] Categorisation unchanged (unknown effectiveness).

Hyperbaric oxygen therapy New option. Five systematic reviews added.[8][10][23][24][25] Categorised as 'unknown effectiveness'.

Low-air-loss beds Two systematic reviews added.[9][10] Categorisation unchanged (unknown effectiveness).

Low-tech constant-low-pressure supports Two systematic reviews added.[9][10] Categorisation unchanged (unknown effectiveness).

Nutritional supplements (vitamin A, Vitamin C, vitamin E, arginine, protein, zinc, and total calorie) One systematic review added.[10] Categorisation unchanged (unknown effectiveness).

Seat cushions Two systematic reviews added.[9][10] Categorisation unchanged (unknown effectiveness).

Surgery One systematic review added.[10] Categorisation unchanged (unknown effectiveness).

Therapeutic ultrasound One systematic review added.[10] Categorisation unchanged (unknown effectiveness).

Topical negative pressure Two systematic reviews added[10][38] and one additional RCT.[39] Categorisation unchanged (unknown effectiveness).

Abstract

INTRODUCTION: Unrelieved pressure or friction of the skin, particularly over bony prominences, can lead to pressure ulcers in up to one third of people in hospitals or community care, and one fifth of nursing home residents. Pressure ulcers are more likely in people with reduced mobility and poor skin condition, such as older people or those with vascular disease. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments in people with pressure ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (BMJ Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 307 studies. After deduplication and removal of conference abstracts, 203 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 163 studies and the further review of 40 full publications. Of the 40 full articles evaluated, seven systematic reviews and two RCTs were added at this update. We performed a GRADE evaluation for 15 PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for 15 interventions based on information about the effectiveness and safety of air-fluidised supports, alternating-pressure surfaces (including mattresses), debridement, dressings, electrotherapy, hyperbaric oxygen, low-air-loss beds, low-level laser therapy, low-tech constant-low-pressure supports, nutritional supplements, seat cushions, surgery, therapeutic ultrasound, topical negative pressure, and topical phenytoin.

Cite as

Reddy M. Pressure ulcers: treatment. Systematic review 1901. BMJ Clinical Evidence. . 2015 December. Accessed [date].

Latest citations

Validation of the interRAI Pressure Ulcer Risk Scale in Acute Care Hospitals. ( 19 August 2016 )

Antibiotics and antiseptics for pressure ulcers. ( 26 April 2016 )