Summary of GRADE profile 52Adjunctive treatment: Negative pressure wound therapy (NPWT)

No of studiesDesignNPWTControlRelative risk/NNTB
(95% CI)
AbsoluteGRADE quality
Amputation
2
[B, W]
RCT9/246 (3.7%)26/251 (10.4%)RR 0.35 (0.17 to 0.74)
NNTB = 15 (9 to 43)
7 fewer per 100 (from 3 fewer to -9 fewer)Low
Complete wound closure (week 16) (follow-up 16 weeks)
2
[B, W]
RCT116/246 (47.2%)81/251 (32.3%)RR 1.47 (1.18 to 1.84)
NNTB = 7 (4 to 16)
15 more per 100 (from 6 more to 27 more)Low
Mean reduction wound surface area (cm2)
1
[E]
RCT1212Mean reduction (cm2) (SD):
NPWT = 20.4 (11.7); control = 9.5 (4.11)
Mean difference = 10.9 (95%CI: 3.88 to 17.92)
Low
Median time to 75% wound closure (days)
1
[B]
RCT169166Median time (K-M) (days):
NPWT = 58 (95%CI: 53 to 78)
Control = 84 (95%CI: 58 to 89), p = 0.014
Low
Median time to achieve 75%-100% granulation (days) (baseline 0%-25% granulation)
1
[W]
RCT7785Median time (K-M) (days):
NPWT = 42 (95%CI: 14 to 56)
Control = 82 (95%CI: 28 to 112), p = 0.01
Low
Overall ulcer-related AEs
1
[B]
RCT15/169 (8.9%)11/166 (6.6%)RR 1.34 (0.63 to 2.83)
NNTH = N/A
2 more per 100 (from -2 fewer to 12 more)Low
Overall treatment-related AEs
1
[W]
RCT9/77 (11.7%)11/85 (12.9%)RR 0.90 (0.40 to 2.06)
NNTH = N/A
1 fewer per 100 (from 8 fewer to 14 more)Low

[B] = Blume et al. (2008): NPWT + standard care vs. control (moist wound therapy) + standard care. Standard care = off-loading.

[E] = Etoz et al. (2004): NPWT vs. control (saline moistened gauze)

[W] = Williams et al. (2005): NPWT + standard care vs. control (moist wound therapy) + standard care. Standard care = off-loading.

AE = adverse event; CI = confidence interval; K-M = Kaplan-Meier; NNTB = number needed to treat to benefit; NNTH = number needed to treat to harm; RCT = randomised clinical trial; RR = relative risk; SD = standard deviation.

From: 3, Evidence review and recommendations

Cover of Diabetic Foot Problems
Diabetic Foot Problems: Inpatient Management of Diabetic Foot Problems.
NICE Clinical Guidelines, No. 119.
Centre for Clinical Practice at NICE (UK).
Copyright © 2011, National Institute for Health and Clinical Excellence.

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