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 Gray literature, including unpublished data, abstracts, dissertations, and individual product packets from manufacturers, was also reviewed.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.