Home > Full Text Reviews > Pressure Ulcer Risk Assessment and... > Overall Strength of Evidence Tables

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.

Chou R, Dana T, Bougatsos C, et al. Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 May. (Comparative Effectiveness Reviews, No. 87.)

Appendix GOverall Strength of Evidence Tables

Appendix Table G1Strength of evidence for Key Question 1

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Pressure ulcer incidence or severity: Waterlow scale vs. clinical judgment1GoodNot applicable (1 study)DirectLow1,231Low
Pressure ulcer incidence or severity: Norton scale vs. clinical judgment1PoorNot applicable (1 study)DirectLow240Insufficient
Pressure ulcer incidence or severity: Braden scale vs. clinical judgment1PoorNot applicable (1 study)DirectLow521Insufficient

Note: Key Question 1. For adults in various settings, is the use of any risk assessment tool effective in reducing the incidence or severity of pressure ulcers, compared with other risk assessment tools, clinical judgment alone, and/or usual care?

Appendix Table G2Strength of evidence for Key Question 1a

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Not relevant0No evidenceNo evidenceNo evidenceNo evidenceNo evidenceInsufficient

Note: Key Question 1a. Does the effectiveness and comparative effectiveness of risk assessment tools differ according to setting?

Appendix Table G3Strength of evidence for Key Question 1b

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Not relevant0No evidenceNo evidenceNo evidenceNo evidenceNo evidenceInsufficient

Note: Key Question 1b. Does the effectiveness and comparative effectiveness of risk assessment tools differ according to patient characteristics, and other known risk factors for pressure ulcers, such as nutritional status or incontinence?

Appendix Table G4Strength of evidence for Key Question 2

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Diagnostic accuracy: Braden ScaleAUROC: 7
Sensitivity/specificity, cutoff ≤18: 16; all cut-offs: 32
FairModerateDirectModerateAUROC: 4,811
Sensitivity/specificity, cutoff ≤18: 5,462; all cut-offs: 11,596
Moderate
Diagnostic accuracy: Norton scaleAUROC: 3
Sensitivity/specificity, cutoff ≤14: 5; all cut-offs: 12
FairModerateDirectLowAUROC: 4,191
Sensitivity/specificity:
Cutoff ≤14: 2,809
All cut-offs: 5,910
Moderate
Diagnostic accuracy: Waterlow scaleAUROC: 4
Sensitivity/specificity, cutoff ≥10: 2; all cut-offs: 10
FairModerateDirectLowAUROC: 2,559
Sensitivity/specificity, cutoff ≥10: 419
all cut-offs: 3,979
Moderate
Diagnostic accuracy: Cubbin and Jackson scaleAUROC: 3
Sensitivity/specificity, cutoff ≤24 to 29: 3
FairModerateDirectLowAUROC: 865
Sensitivity/specificity, cutoff ≤24 to 29: 865
Moderate
Diagnostic accuracy: Direct comparisons between risk assessment scalesAUROC: 6
Sensitivity/specificity, all scales, common cut-offs: 8; all scales, all cut-offs: 14
FairModerateDirectModerateAUROC: 5,921
Sensitivity/specificity, all scales, common cut-offs: 4,637
all scales, all cut-offs: 6,528
Moderate

Note: Key Question 2. How do various risk assessment tools compare with one another in their ability to predict the incidence of pressure ulcers?

Appendix Table G5Strength of evidence for Key Question 2a

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Diagnostic accuracy: Braden scale, across settings (direct evidence)29FairModerateIndirectLow10,705Low
Diagnostic accuracy: Cubbin and Jackson, ICU setting2FairModerateDirectLow646Low
Diagnostic accuracy: Braden scale, optimal cutoff in different settings9FairModerateIndirectLow3,654Low

Note: Key Question 2a. Does the predictive validity of various risk assessment tools differ according to setting?

Appendix Table G6Strength of evidence for Key Question 2b

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Diagnostic accuracy: Braden scale, differences according to race2FairLowDirectLow917Low
Diagnostic accuracy: Braden scale, differences according to baseline pressure ulcer risk3FairModerateDirectLow3,535Moderate

Note: Key Question 2b. Does the predictive validity of various risk assessment tools differ according to patient characteristics?

Appendix Table G7Strength of evidence for Key Question 3

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Pressure ulcer incidence or severity: Advanced static mattresses or overlays vs. a standard hospital mattress12FairHighDirectModerate2,533Moderate
Pressure ulcer incidence or severity: Advanced static mattress or overlay vs. advanced static mattress or overlay11FairModerateDirectModerate1,170Moderate
Pressure ulcer incidence or severity: Low-air-loss bed vs. standard hospital mattress2FairLowDirectLow134Low
Pressure ulcer incidence or severity: Low-air-loss mattresss versus dual option (constant low pressure/alternating air) mattress1FairNot applicable (1 study)DirectLow62Low
Pressure ulcer incidence or severity: Alternating air pressure overlay or mattress vs. standard hospital mattress3PoorHighDirectModerate768Low
Pressure ulcer incidence or severity: Alternating air pressure overlay or mattress vs. advanced static overlay or mattress6FairModerateDirectModerate1,339Moderate
Pressure ulcer incidence or severity: Alternating air pressure overlay or mattress vs. alternating air pressure overlay or mattress4FairModerateDirectModerate2,734Moderate
Pressure ulcer incidence or severity: Heel ulcer supports or boots vs. usual care2FairLowDirectLow291Low
Pressure ulcer incidence or severity: Heel ulcer preventive intervention vs. heel ulcer preventive intervention1PoorNot applicable (1 study)DirectLow240Insufficient
Pressure ulcer incidence or severity: More sophisticated wheelchair cushions vs. standard wheelchair cushions4FairLowDirectModerate653Low
Pressure ulcer incidence or severity: Nutritional supplementation vs. standard hospital diet6PoorModerateDirectLow1,553Low
Pressure ulcer incidence or severity: Repositioning intervention vs. usual care4FairModerateDirectLow1,332Low
Pressure ulcer incidence or severity: Small, unscheduled shifts in body position vs. usual care2PoorHighDirectLow34Low
Pressure ulcer incidence or severity: Silicone border foam sacral dressing vs. no silicone border foam dressing1FairNot applicable (1 study)DirectLow85Low
Pressure ulcer incidence or severity: REMOIS pad vs. no pad1PoorNot applicable (1 study)DirectLow37Insufficient
Pressure ulcer incidence or severity: Changing incontinence pad three vs. two times daily1FairNot applicable (1 study)DirectLow81Low
Pressure ulcer incidence or severity: Intraoperative warming vs. usual care1FairNot applicable (1 study)DirectLow324Low
Pressure ulcer incidence or severity: Corticotropin vs. sham1PoorNot applicable (1 study)DirectLow85Insufficient
Pressure ulcer incidence or severity: Polarized light1PoorNot applicable (1 study)DirectLow23Insufficient
Pressure ulcer incidence or severity: Fatty acid cream vs. placebo2FairModerateDirectModerate417Low
Pressure ulcer incidence or severity: Other cream or lotion vs. placebo3PoorModerateDirectLow534Insufficient
Pressure ulcer incidence or severity: Skin cleanser vs. standard soap and water1FairNot applicable (1 study)DirectLow93Low

Note: Key Question 3. In patients at increased risk of developing pressure ulcers, what is the effectiveness and comparative effectiveness of preventive interventions in reducing the incidence or severity of pressure ulcers?

Appendix Table G8Strength of evidence for Key Question 3a

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Pressure ulcer incidence or severity: Static foam overlay vs. standard care, lower-risk surgical population2GoodHighDirectLow588Moderate
Pressure ulcer incidence or severity: Static dry polymer overlay vs. standard care, lower-risk surgical population2FairHighDirectLow921Low
Pressure ulcer incidence or severity: Static foam block mattress vs. standard care, lower-risk surgical population1PoorNot applicable (1 study)DirectLow1,729Insufficient
Pressure ulcer incidence or severity: Alternating air vs. static mattress or overlay, lower-risk surgical population2FairHighDirectLow415Low

Note: Key Question 3a. Does the effectiveness and comparative effectiveness of preventive interventions differ according to risk level as determined by different risk assessment methods and/or by particular risk factors?

Appendix Table G9Strength of evidence for Key Question 3b

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Not relevantNo evidenceNo evidenceNo evidenceNo evidenceNo evidenceNo evidenceInsufficient

Note: Key Question 3b. Does the effectiveness and comparative effectiveness of preventive interventions differ according to setting?

Appendix Table G10Strength of evidence for Key Question 3c

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Not relevantNo evidenceNo evidenceNo evidenceNo evidenceNo evidenceNo evidenceInsufficient

Note: Key Question 3c. Does the effectiveness and comparative effectiveness of preventive interventions differ according to patient characteristics?

Appendix Table G11Strength of evidence for Key Question 4

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Harms: Support surfaces9FairModerateDirectLow4,524Low*
Harms: Nutritional supplementation1FairNot applicable (1 study)DirectLow129Low*
Harms: Repositioning2FairModerateDirectLow884Low*
Harms: Lotions, creams and cleansers3FairModerateDirectLow424Low*
Harms: Dressings1PoorNot applicable (1 study)DirectLow37Low*

Note: Key Question 4. What are the harms of interventions for the prevention of pressure ulcers?

Appendix Table G12Strength of evidence for Key Question 4a

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Not relevantNo evidenceNo evidenceNo evidenceNo evidenceNo evidenceNo evidenceInsufficient

Note: Key Quesiton 4a. Do the harms of preventive interventions differ according to the type of intervention?

Appendix Table G13Strength of evidence for Key Question 4b

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Not relevantNo evidenceNo evidenceNo evidenceNo evidenceNo evidenceNo evidenceInsufficient

Note: Key Question 4b. Do the harms of preventive interventions differ according to setting?

Appendix Table G14Strength of evidence for Key Question 4c

DetailsNumber of studiesQuality (Good, Fair, Poor)Consistency (High, Moderate, Low)Directness (Direct or indirect)Precision (High, Moderate, Low)Number of subjectsStrength of evidence
Not relevantNo evidenceNo evidenceNo evidenceNo evidenceNo evidenceNo evidenceInsufficient
*

Selective reporting of harms also noted.

Note: Key Question 4c. Do the harms of preventive interventions differ according to patient characteristics?

Appendix G Reference

  • Owens D, Lohr KN, Atkins D, et al. AHRQ Series Paper 5: Grading the strength of a body of evidence when comparing medical interventions—Agency for Healthcare Research and Quality and the Effective Health Care Program. J Clin Epidemiol. 2010;63(5):513–23. [PubMed: 19595577]
Cover of Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness
Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness [Internet].
Comparative Effectiveness Reviews, No. 87.
Chou R, Dana T, Bougatsos C, et al.

PubMed Health Blog...

read all...

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...