Norwegian studies imply that between 7 and 15 per cent of inpatients develop pressure ulcers. They develop more often in specific groups of patients, like patients with spinal cord injury, hip fracture and patients in intensive care. Pressure ulcers are areas of localized damage to the skin and underlying tissue, believed to be caused by pressure, shear force or friction. Pressure ulcers occur fast, and have been documented to develop within one hour. Age, immobility, inadequate nutrition, sensory deficiency, multiple comorbidities, reduced activity, circulatory abnormalities, and dehydration have been identified as some of the risk factors. We included seven systematic reviews on prevention of pressure ulcers published in the Cochrane Database of Systematic Reviews in 2010 or later.Nutritional supplements consisting of both energy and protein probably make little or no difference in the reduction of the development of pressure ulcers in patients with poor nutritional status. Some mattresses probably reduce the development of pressure ulcers compared to standard foam hospital mattresses. Standard foam hospital mattresses are seldom described. The documentation identified is not sufficient for guiding a choice between various foam mattresses. There is a need for an overview of mattresses and pillows that could help the health services to make wise choices in the procurement process. Dressings applied over bony prominences may reduce the development of pressure ulcers. For several interventions there is uncertainty if they have effect, due to few studies. These interventions comprise repositioning, frequency of repositioning, other types of surfaces compared to alternating pressure, various risk assessment tools, and topical agents applied on bony prominences. Many interventions were evaluated in just one study. To obtain a more trustworthy result, it is necessary that the studies are repeated.
BACKGROUND: Numerous, often multi-faceted regimens are available for treating complex wounds, yet the evidence of these interventions is recondite across the literature. We aimed to identify effective interventions to treat complex wounds through an overview of systematic reviews.
METHODS: MEDLINE (OVID interface, 1946 until October 26, 2012), EMBASE (OVID interface, 1947 until October 26, 2012), and the Cochrane Database of Systematic Reviews (Issue 10 of 12, 2012) were searched on October 26, 2012. Systematic reviews that examined adults receiving care for their complex wounds were included. Two reviewers independently screened the literature, abstracted data, and assessed study quality using the Assessment of Multiple Systematic Reviews (AMSTAR) tool.
RESULTS: Overall, 99 systematic reviews were included after screening 6,200 titles and abstracts and 422 full-texts; 54 were systematic reviews with a meta-analysis (including data on over 54,000 patients) and 45 were systematic reviews without a meta-analysis. Overall, 44% of included reviews were rated as being of high quality (AMSTAR score ≥8). Based on data from systematic reviews including a meta-analysis with an AMSTAR score ≥8, promising interventions for complex wounds were identified. These included bandages or stockings (multi-layer, high compression) and wound cleansing for venous leg ulcers; four-layer bandages for mixed arterial/venous leg ulcers; biologics, ultrasound, and hydrogel dressings for diabetic leg/foot ulcers; hydrocolloid dressings, electrotherapy, air-fluidized beds, and alternate foam mattresses for pressure ulcers; and silver dressings and ultrasound for unspecified mixed complex wounds. For surgical wound infections, topical negative pressure and vacuum-assisted closure were promising interventions, but this was based on evidence from moderate to low quality systematic reviews.
CONCLUSIONS: Numerous interventions can be utilized for patients with varying types of complex wounds, yet few treatments were consistently effective across all outcomes throughout the literature. Clinicians and patients can use our results to tailor effective treatment according to type of complex wound. Network meta-analysis will be of benefit to decision-makers, as it will permit multiple treatment comparisons and ranking of the effectiveness of all interventions. Please see related article: http://dx.doi.org/10.1186/s12916-015-0326-3.
Norwegian studies imply that between 7 and 15 per cent of inpatients develop pressure ulcers. They develop more often in specific groups of patients, like patients with spinal cord injury, hip fracture and patients in intensive care. Pressure ulcers are areas of localized damage to the skin and underlying tissue, believed to be caused by pressure, shear force or friction. Pressure ulcers occur fast, and have been documented to develop within one hour. Age, immobility, inadequate nutrition, sensory deficiency, multiple comorbidities, reduced activity, circulatory abnormalities, and dehydration have been identified as some of the risk factors. We included seven systematic reviews on prevention of pressure ulcers published in the Cochrane Database of Systematic Reviews in 2010 or later.Nutritional supplements consisting of both energy and protein probably make little or no difference in the reduction of the development of pressure ulcers in patients with poor nutritional status. Some mattresses probably reduce the development of pressure ulcers compared to standard foam hospital mattresses. Standard foam hospital mattresses are seldom described. The documentation identified is not sufficient for guiding a choice between various foam mattresses. There is a need for an overview of mattresses and pillows that could help the health services to make wise choices in the procurement process. Dressings applied over bony prominences may reduce the development of pressure ulcers. For several interventions there is uncertainty if they have effect, due to few studies. These interventions comprise repositioning, frequency of repositioning, other types of surfaces compared to alternating pressure, various risk assessment tools, and topical agents applied on bony prominences. Many interventions were evaluated in just one study. To obtain a more trustworthy result, it is necessary that the studies are repeated.
