Pressure ulcer treatment strategies: A systematic comparative effectiveness review

M. E. Beth Smith, Annette Totten, David H. Hickam, Rongwei (Rochelle) Fu, Ngoc Wasson, Basmah Rahman, Makalapua Motu'apuaka, Somnath (Som) Saha

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Background: Pressure ulcers affect as many as 3 million Americans and are major sources of morbidity, mortality, and health care costs. Purpose: To summarize evidence comparing the effectiveness and safety of treatment strategies for adults with pressure ulcers. Data Sources: MEDLINE, EMBASE, CINAHL, Evidence-Based Medicine Reviews, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Health Technology Assessment Database for English- or foreign-language studies; reference lists; gray literature; and individual product packets from manufacturers (January 1985 to October 2012). Study Selection: Randomized trials and comparative observational studies of treatments for pressure ulcers in adults and noncomparative intervention series (n > 50) for surgical interventions and evaluation of harms. Data Extraction: Data were extracted and evaluated for accuracy of the extraction, quality of included studies, and strength of evidence. Data Synthesis: 174 studies met inclusion criteria and 92 evaluated complete wound healing. In comparison with standard care, placebo, or sham interventions, moderate-strength evidence showed that air-fluidized beds (5 studies [n = 908]; high consistency), protein-containing nutritional supplements (12 studies [n = 562]; high consistency), radiant heat dressings (4 studies [n = 160]; moderate consistency), and electrical stimulation (9 studies [n = 397]; moderate consistency) improved healing of pressure ulcers. Low-strength evidence showed that alternating-pressure surfaces, hydrocolloid dressings, platelet-derived growth factor, and light therapy improved healing of pressure ulcers. The evidence about harms was limited. Limitation: Applicability of results is limited by study quality, heterogeneity in methods and outcomes, and inadequate duration to assess complete wound healing. Conclusion: Moderate-strength evidence shows that healing of pressure ulcers in adults is improved with the use of air-fluidized beds, protein supplementation, radiant heat dressings, and electrical stimulation.

Original languageEnglish (US)
Pages (from-to)39-50
Number of pages12
JournalAnnals of Internal Medicine
Volume159
Issue number1
DOIs
StatePublished - Jul 2 2013

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Pressure Ulcer
Databases
Bandages
Wound Healing
Electric Stimulation
Hydrocolloid Bandages
Therapeutics
Hot Temperature
Air
Biomedical Technology Assessment
Phototherapy
Information Storage and Retrieval
Evidence-Based Medicine
Platelet-Derived Growth Factor
MEDLINE
Health Care Costs
Observational Studies
Proteins
Language
Placebos

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Pressure ulcer treatment strategies : A systematic comparative effectiveness review. / Beth Smith, M. E.; Totten, Annette; Hickam, David H.; Fu, Rongwei (Rochelle); Wasson, Ngoc; Rahman, Basmah; Motu'apuaka, Makalapua; Saha, Somnath (Som).

In: Annals of Internal Medicine, Vol. 159, No. 1, 02.07.2013, p. 39-50.

Research output: Contribution to journalArticle

Beth Smith, M. E. ; Totten, Annette ; Hickam, David H. ; Fu, Rongwei (Rochelle) ; Wasson, Ngoc ; Rahman, Basmah ; Motu'apuaka, Makalapua ; Saha, Somnath (Som). / Pressure ulcer treatment strategies : A systematic comparative effectiveness review. In: Annals of Internal Medicine. 2013 ; Vol. 159, No. 1. pp. 39-50.
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