Pressure Ulcers: Two New Reports from the EHC Program

AHRQ commissioned two systematic reviews of research on the topic. The first addressed risk assessment tools and treatment. In an effort to minimize costs and potential complications, clinicians use many tools to assess a patient's risk for pressure ulcers. But how useful and accurate are these tools? And does their effectiveness differ depending on the patient or the clinical setting? In addition to prevention efforts, there are many treatments options that promote healing, shorten healing time, and minimize the risk of complications from pressure ulcers. But how do they compare to one another?

To answer these questions and compare pressure ulcer risk assessment tools and treatments, let's start a discussion. What are your thoughts on AHRQ's key findings? Do these findings reflect your clinical experience?

For additional key findings, read the executive summaries on Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness and Pressure Ulcer Treatment Strategies: Comparative Effectiveness.

Pressure Ulcer Risk Assessment and Prevention

• In higher-risk populations, studies consistently found advanced static support mattresses and overlays were associated with lower risk of pressure ulcers compared with standard mattresses, with no clear differences between different advanced static support surfaces.
• Evidence on effectiveness of other preventive interventions (nutritional supplementation; pads and dressings; lotions, creams, and cleansers; and intraoperative warming therapy for patients undergoing surgery) compared with standard care was sparse and insufficient to reach reliable conclusions. An exception was repositioning, for which there were three good or fair-quality trials, despite somewhat inconsistent results. One trial found that a repositioning intervention was more effective than usual care in preventing pressure ulcers, although other trials of repositioning did not clearly find decreased risk of pressure ulcers compared with usual care.

Pressure Ulcer Treatment Strategies

• ​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. Most research was of poor quality and had follow-up periods that were too short to assess complete wound healing. This last point is an important and relatively common problem in trying to apply research data to real life. The studies often define the short-term outcome like "smaller ulcer size" rather than the real goal of complete wound healing.

Within the limited research, some evidence can be summarized in a qualitative way; however, definitive conclusions cannot yet be drawn.

• Five studies indicated wound improvement (reduction in ulcer size) was better on air-fluidized beds compared to other support surfaces, including standard hospital beds.
• Four studies indicated a benefit of radiant heat dressings over other dressings and nine studies indicated a benefit of electrical stimulation for wound improvement.
• Studies generally did not provide evidence to support the use of one type of commonly used wound dressing over another. There was evidence that hydrocolloid and foam dressings performed similarly, but evidence for other dressing types--hydrogels, alginates, transparent films, and silicone dressings--compared with each other or with standard gauze dressings was limited.
• Similarly, there was low-strength or insufficient evidence to judge the balance of effectiveness and harms for nutritional supplementation, topical therapies, biological agents, surgical interventions, and adjunctive therapies other than electrical stimulation.

¹Russo, C.A. (Thomson Reuters), Steiner, C. (AHRQ) and Spector, W. (AHRQ). Hospitalizations Related to Pressure Ulcers, 2006. HCUP Statistical Brief #64. December 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb64.pdf