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Cover of Pressure Ulcer Treatment Strategies: Comparative Effectiveness

Pressure Ulcer Treatment Strategies: Comparative Effectiveness

Comparative Effectiveness Reviews, No. 90

Investigators: Somnath Saha, MD, MPH, ME Beth Smith, DO, Annette Totten, PhD, Rongwei Fu, PhD, Ngoc Wasson, MPH, Basmah Rahman, MPH, Makalapua Motu’apuaka, BS, and David H Hickam, MD, MPH.

Oregon Evidence-based Practice Center
Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 May.
Report No.: 13-EHC003-EF
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Structured Abstract

Objectives:

Pressure ulcers affect up to 3 million Americans and are a major source of morbidity, mortality, and health care cost. This review summarizes evidence comparing the effectiveness and safety of pressure ulcer treatment strategies.

Data sources:

Articles published between January 1, 1985, and October 17, 2012, were identified from searches of MEDLINE® (Ovid), Embase (Elsevier), CINAHL (EBSCOhost), EBM Reviews (Ovid), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Health Technology Assessment. Additional studies were identified by searching reference lists from included studies and systematic reviews of pressure ulcer treatments. Gray literature, including unpublished data, abstracts, dissertations, and individual product packets from manufacturers, was also reviewed.

Review methods:

The literature, quality of included studies, and extracted data were dual-reviewed using predefined criteria. Results were summarized in evidence tables. Summary results were derived primarily from qualitative analysis and synthesis.

Results:

We reviewed 7,274 titles and abstracts and 1,836 full-length articles. We included 174 studies (trials and observational studies) addressing the effectiveness and/or harms of different treatments for pressure ulcers. These studies examined a wide range of interventions, but sample sizes often were small. We found moderate-strength evidence that some interventions were associated with wound improvement, including the use of air-fluidized beds (compared with other support surfaces), protein-containing nutritional supplements (compared with placebos or other routine measures of nutritional support), radiant heat dressings (compared with other dressings), and electrical stimulation (compared with a sham treatment). Several other interventions had limited evidence of effectiveness (strength of evidence rated as low). Only a minority of studies examined complete wound healing as an outcome. In general, the evidence about the harms of any of these treatments was limited.

Limitations:

Most studies were of poor quality and had followup periods inadequate to assess complete wound healing. Studies often measured healing outcomes using heterogeneous methods, making it difficult to compare results across studies.

Conclusions:

There was limited evidence to draw firm conclusions about the best approaches for treating pressure ulcers, a finding consistent with other recent reviews on this topic. Future research with larger sample sizes, more rigorous adherence to methodological standards for clinical trials, longer followup periods, and more standardized and clinically meaningful outcome measures is needed to inform clinical practice and policy.

Contents

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10057-I, Prepared by: Oregon Evidence-based Practice Center, Portland, OR

Suggested citation:

Saha S, Smith MEB, Totten A, Fu R, Wasson N, Rahman B, Motu’apuaka M, Hickam DH. Pressure Ulcer Treatment Strategies: Comparative Effectiveness. Comparative Effectiveness Review No. 90. (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-2007-10057-I.) AHRQ Publication No. 13-EHC003-EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10057-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

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AHRQ (US Agency for Healthcare Research and Quality)

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