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CLINICIAN'S CORNER
Preventing Pressure Ulcers: A Systematic Review
Madhuri Reddy, MD, MSc;
Sudeep S. Gill, MD, MSc;
Paula A. Rochon, MD, MPH
JAMA. 2006;296:974-984.
Context Pressure ulcers are common in a variety of patient settings and are associated with adverse health outcomes and high treatment costs.
Objective To systematically review the evidence examining interventions to prevent pressure ulcers.
Data Sources and Study Selection MEDLINE, EMBASE, and CINAHL (from inception through June 2006) and Cochrane databases (through issue 1, 2006) were searched to identify relevant randomized controlled trials (RCTs). UMI Proquest Digital Dissertations, ISI Web of Science, and Cambridge Scientific Abstracts were also searched. All searches used the terms pressure ulcer, pressure sore, decubitus, bedsore, prevention, prophylactic, reduction, randomized, and clinical trials. Bibliographies of identified articles were further reviewed.
Data Synthesis Fifty-nine RCTs were selected. Interventions assessed in these studies were grouped into 3 categories, ie, those addressing impairments in mobility, nutrition, or skin health. Methodological quality for the RCTs was variable and generally suboptimal. Effective strategies that addressed impaired mobility included the use of support surfaces, mattress overlays on operating tables, and specialized foam and specialized sheepskin overlays. While repositioning is a mainstay in most pressure ulcer prevention protocols, there is insufficient evidence to recommend specific turning regimens for patients with impaired mobility. In patients with nutritional impairments, dietary supplements may be beneficial. The incremental benefit of specific topical agents over simple moisturizers for patients with impaired skin health is unclear.
Conclusions Given current evidence, using support surfaces, repositioning the patient, optimizing nutritional status, and moisturizing sacral skin are appropriate strategies to prevent pressure ulcers. Although a number of RCTs have evaluated preventive strategies for pressure ulcers, many of them had important methodological limitations. There is a need for well-designed RCTs that follow standard criteria for reporting nonpharmacological interventions and that provide data on cost-effectiveness for these interventions.
Author Affiliations: Divisions of Geriatric Medicine and Dermatology (Dr Reddy), Department of Medicine (Drs Reddy and Rochon), and Baycrest Kunin-Lunenfeld Applied Research Unit (Dr Rochon), University of Toronto, Toronto, Ontario; Women's College Hospital, Toronto, and Hebrew Rehabilitation Center, Boston, Mass (Dr Reddy); Institute for Clinical Evaluative Sciences, Toronto (Drs Gill and Rochon); and Division of Geriatric Medicine, Departments of Medicine and Community Health and Epidemiology, Queen's University, Kingston, Ontario (Dr Gill).
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