Treatment Of Pressure Ulcers Research Articles

Diabetic Human Adipose-Derived Stem Cells Accelerate Pressure Ulcer Healing by Inducing Angiogenesis and Neurogenesis.

Adipose-derived stem cells (ASCs) possess a well-characterized capacity to enhance cutaneous wound healing. However, many controversies exist regarding ASCs from diabetic patients (dASCs). No report exists on the administration of dASCs for the treatment of pressure ulcers. The aim of this study was to compare properties of dASCs and nondiabetic ASCs (nASCs). In addition, we studied if dASCs enhanced pressure ulcer healing in a rodent pressure ulcer model and investigated underlying mechanisms. We found similar expression of cell surface markers and characteristics in dASCs and nASCs, although dASCs exhibited decreased proliferation and osteogenic differentiation capacity and enhanced adipogenic differentiation capacity. dASCs had beneficial effects on chronic wound healing, though some aspects of their capacity were impaired. The ability of dASCs to promote nerve regeneration was not compromised. dASCs promoted pressure ulcer healing and improved healing by modulating inflammation, promoting angiogenesis and neuroregeneration, enhancing collagen deposition, and increasing re-epithelization. These data may provide a theoretical foundation for further clinical administration of ASCs for chronic wound healing in patients with diabetes.

Quality of reporting of outcomes in trials of therapeutic interventions for pressure ulcers in adults: a protocol for a systematic survey

Pressure ulcers (PUs) have a high incidence, especially in hospital units. Randomised clinical trials (RCTs) of therapeutic interventions for PU should include a clear description of the outcomes and results...

Performance and Influencing Factors of Evidence-Based Pressure Ulcer Care Among Acute Care Hospital Nurses.

In previous studies about performance or factors affecting pressure ulcer (PU) care, old tools with nonupdated contents about the prevention and intervention of PU have been mainly used. Thus, there is little known how well evidence-based PU care is performed and what its' influencing factors are recently. This study aimed to evaluate the PU care performance, based on evidence-based practice guidelines, and identify factors affecting it while considering nurses' individual and institutional characteristics. We recruited 199 nurses involved in PU care, from August 20 to September 10, 2016, at two PU-related academic conferences in Korea. To examine PU care performance and knowledge as a related factor, we developed tools based on recent guidelines. To identify factors affecting PU care performance, we examined nurses' (individual level) and their institutions' (institutional level) characteristics, and analyzed using a hierarchical multiple regression test. Mean PU care performance of nurses was rated 3.99 out of 5. Performance level in "wound care: debridement"; "pain control"; "prevention skin care"; "incontinence management"; "supporting surface"; and "nutrition in PU prevention and treatment" was below average. Interest in PU care (β=.28, p=<.001), the main PU manager in a ward being a wound, ostomy, continence nurse (β=.22, p=.013), and an institution with a nursing practice guideline for PU care (β=.16, p=.02) were identified as significant factors affecting a good PU care performance. To improve nurses' evidence-based PU care performance, nurses must recognize PU care's importance and take responsibility for improving their own performance. At the institutional level, systematic evidence-based guidelines and support systems, such as activating wound specialists, must be implemented. The academic society can support these initiatives by updating continuously the national guideline on PU prevention and management for ease of use by nurses or institutions.

Preventive interventions for pressure ulcers in long-term older people care facilities: A systematic review.

To explore the effectiveness of interventions aimed at pressure ulcer (PU) prevention in long-term older people care facilities (LOPC). Pressure ulcers cause suffering for patients and constitute a major financial burden. Although most PUs could be prevented, their number has remained high. To avoid unnecessary suffering and costs, PU prevention must be effective. A systematic review. A systematic search was conducted in six electronic databases PubMed (MEDLINE), CINAHL, Web of Science Core Collection, Scopus, Cochrane Wounds Group Specialized Register and Cochrane Central Register of Controlled Trials. The inclusion criteria were: (a) study published in 2005-2017, (b) intervention with pre- and post-tests, focusing on PU prevention, (c) implemented in LOPC facilities, (d) persons >65years as study population, and (e) outcomes reported as PU incidence or prevalence or healing time. The PRISMA guidelines were followed. The methodological quality of the studies was evaluated using the Joanna Briggs Institute's MAStARI critical appraisal checklist. The data were analysed with narrative synthesis. The review included eighteen studies. The study designs were RCTs (n=10), comparable cohort or case-control studies (n=3), and descriptive or case series (n=5). PU incidence in LOPC facilities decreased by using computerised decision-making support systems, PU prevention programmes, repositioning or advanced cushions. PU prevalence decreased with PU prevention programmes, by using advanced mattresses and overlays, or by adding protein and energy supplements to diet. There are many ways to prevent PUs in LOPC facilities; no single effective way can be identified. One-third of the preventive interventions in LOPC facilities were effective. However, systematic evidence from randomised trials on preventive interventions of PUs in LOPC settings is still lacking. The findings can be used in practice for selecting and in research for developing effective preventive interventions of PUs in LOPC facilities.

Hospital based care at home; study protocol for a mixed epidemiological and randomized controlled trial

BackgroundIndividuals with spinal cord injuries (SCI) are prone to pressure ulcers (PUs) because of the loss of sensorimotor function involved as well as increased skin moisture. Treatment of PU after SCI is complicated, involving different specialties and with need for long-lasting follow-up. This study should identify risk factors for PU after SCI, and find an effective and less time-consuming treatment for the condition among different available methods for follow-up.Method/designThe first part of this research project aims to investigate the prevalence of PU among persons with SCI based on an epidemiological design. The study will identify possible risk factors for acquiring PU. A questionnaire focusing on previous and present PUs will be sent to persons who suffered SCIs between January 2004 and January 2014. In the second part we will compare two different treatment regimens of PU through a randomized controlled pilot trial (RCT) where we will compare outpatient SCI follow-up in a hospital versus outpatient follow-up from the patient’s home, using telemedicine (teleSCI) interventions. We will compare the healing of the PU in the two groups (usual care versus teleSCI). The Tissue, Infection, Moisture Edge (TIME) registration form, the Photographic Wound Assessment Tool (PWAT) and the change in the ulcer size will be used to monitor the healing. Changes in health-related quality of life (HRQoL) and the need for assistance will be assessed using the Five Dimensions European Quality of Life scale (EQ-5D), the generic Medical Outcomes Study 12-item Short Form Health Survey (SF-12) modified version, the International Spinal Cord Injury Quality of Life Data set (ISCI-QoL Data set), and the Spinal Cord Independence Measure scale, version III (SCIM III). In addition to primary outcome measures, a cost-benefit evaluation and an assessment of patient satisfaction and participation will be performed, using customized questionnaires.DiscussionThe first part of the research project will reveal the epidemiology of PU after SCI, and explore the risk factors. This part enables further prevention of PU after SCI and this information will be used in the follow-up RCT. Videoconferencing in the outpatient follow-up of persons with SCI and PU will change clinical routines and facilitate interdisciplinary collaboration, communication and competence exchange among participants of the health care services. Our research protocol allows comparing methods for interaction between medical specialists at hospitals, local caregivers in the community, next of kin, and persons with SCI and PU. The RCT should identify advantages as well as challenges in the management of PU in different follow-up settings. This study aims to identify risk factors for PU after SCI, and find an effective and less time consuming treatment for the condition among different available methods for follow- up.Trial registrationwww.ClinicalTrials.gov, ID: NCT02800915, last update 9 October 2017.The National Regional Ethical Committee (REC) 2014/ 684/ REK-Nord. https://helseforskning.etikkom.no/prosjekterirek/prosjektregister/prosjekt?p_document_id=469163&p_parent_id=473640&_ikbLanguageCode=nhttps://app.cristin.no/projects/show.jsf?id=545284https://www.sunnaas.no/kliniske-studier/bruk-av-telemedisin-som-virkemiddel-til-samhandling-i-poliklinisk-oppfolging-av-pasienter-med-ryggmargsskade-og-trykksar

Dynamic changes in seating pressure gradient in wheelchair users with spinal cord injury

ABSTRACT Pressure ulcer interventions are commonly assessed with measures of seating interface pressure, such as peak pressure gradients (PPGs). Decreases in PPG magnitudes may reduce pressure ulcer risk by decreasing tissue deformation and increasing tissue perfusion of at-risk weight-bearing tissues. Changes in PPG directions, which have previously been overlooked in the seating pressure literature, may provide a transient increase in blood flow to at-risk tissues, even if the PPG magnitude and location remain the same. The purpose of this study was to assess both PPG components in response to combinations of wheelchair tilt and recline angles. Thirteen power wheelchair users were recruited into the study. Six combinations of wheelchair tilt (15°, 25°, and 35°) and recline (10° and 30°) were tested in random order. Each combination was tested with 5-min upright sitting, 5-min tilt and recline, and 5-min maximal pressure relief recovery. Changes in PPG magnitudes and PPG directions under the left ischial tuberosity were computed for the six angle combinations. The findings in this study suggested that when combining wheelchair tilt and recline, the recline function may be particularly useful in reducing PPG magnitudes, while the tilt function may be particularly useful in manipulating PPG directions.

Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019

AimThe European Pressure Ulcer Advisory Panel, the Pan Pacific Pressure Injury Alliance, and the National Pressure Ulcer Advisory Panel are updating the ‘Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline’ (CPG) in 2019. The aim of this contribution is to summarize and to discuss the guideline development protocol for the 2019 update. MethodsA guideline governance group determines and monitors all steps of the CPG development. An international survey of consumers will be undertaken to establish consumer needs and interests. Systematic evidence searches in relevant electronic databases cover the period from July 2013 through August 2018. Risk of bias of included studies will be assessed by two reviewers using established checklists and an overall strength of evidence assigned to the cumulative body of evidence. Small working groups review the evidence available for each topic, review and/or draft the guideline chapters and recommendations and/or good practice statements. Finally, strength of recommendation grades are assigned. The recommendations are rated based on their importance and their potential to improve individual patient outcomes using an international formal consensus process. DiscussionMajor methodological advantages of the current revision are a clear distinction between evidence-based recommendations and good practice statements and strong consumer involvement. ConclusionThe 2019 guideline update builds on the previous 2014 version to ensure consistency and comparability. Methodology changes will improve the guideline quality to increase clarity and to enhance implementation and compliance. The full guideline development protocol can be accessed from the guideline website (http://www.internationalguideline.com/).

Using Beeswax, Olive Oil and Centaury Oil for Pressure Ulcers

When soft tissues are exposed to pressure, ischemia occurs. If the pressure becomes continuous, necrosis starts in the subcutaneous tissue and gradually progresses to the surface and finally the skin is affected. Different methods are used in the treatment of pressure ulcers. As in all the other fields of health, observation is very important in the care and monitoring of a wound. In this case report, the effect of beeswax, olive oil and centaury oil on wound healing is presented in a 24-year old patient with hypoxic brain with a 3rd degree pressure.

Reconstruction of Lumbar Spinal Defects: Case Series, Literature Review, and Treatment Algorithm.

Background:Lumbar spinal defects present a distinct challenge for the reconstructive surgeon and are often complicated by previous spinal surgery, the presence of hardware, and prior radiation. There are a variety of reconstructive options described but no clear treatment algorithm for these challenging defects.Methods:A literature search was performed to review the described treatment options for lumbar spinal soft-tissue defects. Treatments for myelomeningocele or pressure ulcers were excluded. In addition, a retrospective case review was performed for patients with lumbar defects treated with pedicled superior gluteal artery perforator (SGAP) flap reconstruction.Results:A literature review revealed 2,022 articles pertaining to lumbar defect reconstruction, of which 56 met inclusion criteria. These articles described 13 individual reconstructive techniques for this anatomic area. The most commonly described techniques were evaluated and a treatment algorithm designed based on patient and wound characteristics. The clinical course of 5 patients with radiated lumbar spinal defects treated with SGAP flaps is presented.Conclusions:There are many treatment options for lumbar spinal defects and treatment should be tailored to the patient and the characteristics of the defect. For large or radiated lumbar wounds, the pedicled SGAP flap is an excellent reconstructive choice, as it has reliable anatomy that is outside the zone of injury, adequate bulk, and minimal donor-site deficits.

Diabetic Pressure Ulcer Treatment Methods and Maggot Therapy - Review

Diabetic Pressure Ulcer Treatment Methods and Maggot Therapy - Review

Operative treatment of pressure ulcers using pedicled flaps

Purpose: To present the results of surgical treatment concerning pressure ulcers. Materials and methods: All patients underwent surgical treatment at the Orthopedics and Traumatology Clinic from 1997 to 2016. One operator performed the procedures. A total of 28 pressure ulcers were operated (25 patients). The clinical material consisted of 15 pressure ulcers located in the lower back area, six pressure ulcers located in the ischial area, three pressure ulcers located in the trochanteric area and four pressure ulcers located in the heel area. Results: One conducted the result evaluation based on the criteria of complications proposed by Seiler. In case of all surgically treated patients, pressure ulcers appeared after 2-5 weeks after the surgery. One patient experienced hematoma below the slide piece. One could observe seroma in case of 5 patients. In this situation, it was required to apply a local postoperative puncture. Four patients experienced marginal skin necrosis (2 of them required resection of dead skin edges in operating block conditions which were later re-stitched using “side to side” technique). During the 3-year follow-up, there was no recurrence of operated pressure ulcers. Conclusions: Deep septic pressure ulcers, according to the division introduced by Seiler, connected with bone infection require the application of muscular-skin pieces. This procedure is aimed at improving local tissue blood supply. Proper preoperative preparation of the patient, careful planning of the surgery and suitable postoperative treatment of the patient are as significant as the surgery itself.

Organisation of health services for preventing and treating pressure ulcers.

Organisation of health services for preventing and treating pressure ulcers.

An overview of co-morbidities and the development of pressure ulcers among older adults

BackgroundThe prevalence of pressure ulcers particularly in the frail older adult population continues to be high and very costly especially in those suffering from chronic diseases and has brought a higher awareness to comprehensive, preventive and therapeutic measures for treatment of pressure ulcers. Internal risk factors highlighted by comorbidities play a crucial role in the pathogenesis of pressure ulcers.Main bodyFocusing on the impact of common chronic diseases (comorbidities) in aging on pressure ulcers (e.g., cardiovascular diseases, diabetes, chronic pulmonary diseases, renal diseases and neurodegenerative disorders) and the significant complicating conditions e.g., anemia, infectious diseases, malnutrition, hospitalization, incontinence and polypharmacy, frailty and disability becomes important in developing a more complete, inclusive and multidisciplinary approach to prevention of PU in older patients.ObjectiveTo describe chronic and acute conditions which are risk factors in elderly patients for developing PU.MethodsWe present an overview of comorbidities seen with PU in three diverse patient locations.The inclusion criteria are sites (community, acute hospital and long term facilities), older patients, chronic diseases and pressure ulcers grade 2 and over.Using a recently developed conceptual framework accepted by European and National Pressure Ulcer Advisory Panels, we examined chronic diseases to identify the risk factors of chronic conditions and complicating conditions which potentially influence risk for PU development.ConclusionMultiple chronic diseases and complicating factors which associated with immobility, tissue ischemia, and undernutrition are caused to PU in community settings, hospitals, and nursing facilities.

An extracellular matrix graft (Oasis® wound matrix) for treating full-thickness pressure ulcers: A randomized clinical trial

AimThe purpose of the study was to evaluate clinical safety and effectiveness of Oasis® Wound Matrix as a treatment for full-thickness pressure ulcers and compare it to Standard Care. MethodsA total of 130 adults with Stage III or Stage IV pressure ulcers were randomly assigned, received either multiple topical treatments of SIS plus standard care (n = 67), or standard care alone (n = 63), and were subsequently evaluated. Ulcer size was determined at enrollment and weekly throughout treatment. Healing was assessed at each visit for a period of up to 12 weeks, with incidence of complete healing and 90% reduction in ulcer area being the primary outcome measures. ResultsThe proportion of complete healing in the SIS group was 40% as compared to 29% in the standard of care group (p = 0.111); the percentage of patients having a 90% reduction in ulcer surface area was 55% in the SIS group versus 38% in the standard of care group (p = 0.037). ConclusionsThe results of this study suggest that within the setting of a comprehensive wound care program, weekly treatment of chronic pressure ulcers with SIS wound matrix increases the incidence of 90% reduction in wound size versus standard of care alone.

Flexor muscle disconnection combined with myocutaneous flap for pressure ulcer in patients of ankylosing posture

Objective To investigate the efficacy of flexor muscle disconnection combined with myocutaneous flap in the treatment of pressure ulcer in patients of ankylosing posture. Methods A retrospective case series study was conducted to analyze 15 patients with pressure ulcer at different body parts due to ankylosing posture after paraplegia admitted to the First Affiliated Hospital of Jinan University from January 2012 to July 2017. There were 10 males and five females, aged 40-78 years, with an average age of 68 years. The pressure ulcer ranged from 3 cm×3 cm to 15 cm×11 cm. The pressure ulcers were distributed at sacrococcygeal region in eight patients, macro-rotator in four, and ischial nodules in three. According to the size and position of pressure ulcer, different musculocutaneous flaps were selected, and high selective decompression of hip flexion and knee flexion was performed to ensure the tension free suture of the wound. After the operation, the negative pressure closed drainage (VSD) was given to maintain a proper posture for wound healing. The stitches were removed after the wound healed. The wound healing, pressure ulcer recurrence, flap texture, flap color, and donor site were observed, and patient satisfaction were also surveyed. Results All patients were followed up for 12-36 months, average 24 months. The pressure ulcer was healed in 12 patients after the first repair operation. In two nonunion cases, the unrelieved knee flexion and knee muscles led to high muscular tension and stiff joint, causing strong resistance during limb movement and strong flexor reflex. Two patients were healed after twice operation. In one patient, the incision was torn by the excessive flexion tension due to improper body position caused by the passive movement of the limb after operation, and the wound was healed after twice operation. All muscle flaps covered the wound and survived well, and the wounds were completely closed and healed with good shape, texture as well as elastic recovery. After the suture was removed 18 days after surgery, the patients were discharged satisfactorily. The patients received conventional pressure ulcer care, and no new pressure ulcer was reported during the follow-up. The flap donor site was healed well after autologous skin repair. Conclusion For pressure ulcer in patients of ankylosing posture, flexor muscle disconnection combined with myocutaneous flap has notable effects in reducing tension and can accelerate wound healing and improve healing rate. Key words: Pressure ulcer; Surgical flaps; Reconstructive surgical procedures; Closed negative pressure drainage

The Cost Analysis of Pressure Ulcer Treatment; The Treatment Cost Comparison of Conventional and Modern Wound Care

The Cost Analysis of Pressure Ulcer Treatment; The Treatment Cost Comparison of Conventional and Modern Wound Care

Support surfaces for treating pressure ulcers.

Pressure ulcers are treated by reducing pressure on the areas of damaged skin. Special support surfaces (including beds, mattresses and cushions) designed to redistribute pressure, are widely used as treatments. The relative effects of different support surfaces are unclear. This is an update of an existing review. To assess the effects of pressure-relieving support surfaces in the treatment of pressure ulcers. In September 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. We included published or unpublished randomised controlled trials (RCTs), that assessed the effects of support surfaces for treating pressure ulcers, in any participant group or setting. Data extraction, assessment of 'Risk of bias' and GRADE assessments were performed independently by two review authors. Trials with similar participants, comparisons and outcomes were considered for meta-analysis. Where meta-analysis was inappropriate, we reported the results of the trials narratively. Where possible, we planned to report data as either risk ratio or mean difference as appropriate. For this update we identified one new trial of support surfaces for pressure ulcer treatment, bringing the total to 19 trials involving 3241 participants. Most trials were small, with sample sizes ranging from 20 to 1971, and were generally at high or unclear risk of bias. healing of existing pressure ulcersLow-tech constant pressure support surfacesIt is uncertain whether profiling beds increase the proportion of pressure ulcer which heal compared with standard hospital beds as the evidence is of very low certainty: (RR 3.96, 95% CI 1.28 to 12.24), downgraded for serious risk of bias, serious imprecision and indirectness (1 study; 70 participants).There is currently no clear difference in ulcer healing between water-filled support surfaces and foam replacement mattresses: (RR 0.93, 95% CI 0.63 to 1.37); low-certainty evidence downgraded for serious risk of bias and serious imprecision (1 study; 120 participants).Further analysis could not be performed for polyester overlays versus gel overlays (1 study; 72 participants), non-powered mattresses versus low-air-loss mattresses (1 study; 20 participants) or standard hospital mattresses with sheepskin overlays versus standard hospital mattresses (1 study; 36 participants).High-tech pressure support surfacesIt is currently unclear whether high-tech pressure support surfaces (such as low-air-loss beds, air suspension beds, and alternating pressure surfaces) improve the healing of pressure ulcers (14 studies; 2923 participants) or which intervention may be more effective. The certainty of the evidence is generally low, downgraded mostly for risk of bias, indirectness and imprecision.Secondary outcomesNo analyses were undertaken with respect to secondary outcomes including participant comfort and surface reliability and acceptability as reporting of these within the included trials was very limited.Overall, the evidence is of low to very low certainty and was primarily downgraded due to risk of bias and imprecision with some indirectness. Based on the current evidence, it is unclear whether any particular type of low- or high-tech support surface is more effective at healing pressure ulcers than standard support surfaces.

Investigation and analysis on status quo of pressure ulcer and other skin injuries among inpatients in Class III Grade A hospitals in Hainan province

Objective To investigate and analyze the prevalence of pressure ulcer and other skin injuries, and the implementation of pressure ulcer prevention measures among inpatients in Class Ⅲ Grade A hospitals in Hainan province. To provide basis for fomulating bundle of care model to prevent and intervent pressure ulcer, and establishing early warning management model on nosocomial pressure ulcer in Class Ⅲ Grade A hospitals in Hainan province. Methods A cross-sectional survey was conducted on inpatients from 7 Class Ⅲ Grade A hospitals in Hainan province. A investigation was performed by a self-designed inpatients′ questionnaire and qualified tools on pressure ulcer and other skin injuries. Statistical analysis of data using by SPSS19.0 software. Results The content validity index of the self-designed inpatients′ questionnaire and qualified tools on pressure ulcer and other skin injuries was 0.91, Cronbach α coefficient was 0.93. The prevalence of pressure sores was 2.28%(165/7 248), of which 66.06%(109/165) was family involvement, 30.30%(50/165) was hospital acquired, 3.03%(5/165) was community involvement,and 0.61%(1/165) was both from family and hospital acquired. Medical instrument related pressure ulcer accounted for 18.18%(30/165) of the total number of pressure ulcer. The most common site of pressure ulcer was the sacrococcygeal region, accounting for 47.94%(93/194). The proportion of pressure ulcer in stageⅡ was the highest (35.57%, 69/194). 52.01%(647/1 244) of patients at risk of pressure ulcer did not use the anti-pressure devices,and 81.40%(1 013/1 244) of patients′ main compression sites were not covered by dressings.35.50%(442/1 244) of patients did not according to plans or regularly turn over, only 56.19%(699/1 244) patients turned over every 2 hours. 61.57%(442/1 244) patients who have pressure ulcer did not have anti-pressure ulcer signs. Among other skin injuries: the prevalence of incontinence related dermatitis was 0.88%(64/7 248), and the prevalence of avulsion skin injury was 0.37%(27/7 248). Conclusions The incidence of acquired pressure ulcer in Class Ⅲ Grade A hospitals in our province is slightly higher than other domestic investigation results. The reasons may be that anti-pressure devices in hospital configuration are not enough, lack of the tailored bundle of prevention measures of pressure ulcer, and failure to establish an effective early warning management model on pressure ulcer etc. So prevention and treatment of pressure ulcer should have a further standard management. Instrument related pressure ulcer and incontinence related dermatitis should also attract the attention of clinical nurses and managers. Key words: Pressure ulcer; Skin injury; Investigation; Analysis

Economic Evaluation of Nutrition Support in the Prevention and Treatment of Pressure Ulcers in Acute and Chronic Care Settings: A Systematic Review

Recent developments in nutrition intervention indicated clinical effectiveness for pressure ulcer (PU) prevention and treatment, but it is important to assess whether they are cost-effective. The aims of this systematic review are to determine the cost-effectiveness and clinical outcomes of nutrition support in PU prevention and treatment. A systematic search of randomized controlled trials, observational studies, and statistical models that investigated cost-effectiveness and economic outcomes for prevention and/or treatment of PUs were performed using standard literature and electronic databases. Fourteen studies met the inclusion criteria, which included 3 randomized controlled trials with their companion economic evaluations, 4 model-based, 2 cohort, 1 pre and post, and 1 prospective controlled trial. Risk of bias assessment for all of the uncontrolled or observational trials revealed high or serious risk of bias. Interventions that incorporated specialized nursing care appeared to be more effective in prevention and treatment of PUs, compared with single intervention studies. There is a trend of improved PU healing when additional energy/protein are provided. PU prevention ($250-$9,800) was less expensive than treatment ($2,500-$16,000). Nutrition intervention for PU prevention was cost-effective in 87.0%-99.99% of the simulation models. There is potential cost-saving and/or cost-effectiveness of nutrition support in the long term, as predicted by the model-based PU prevention studies in the review. Prevention of PU also appears to be more cost-effective than treatment. A multidisciplinary approach to managing PU is more likely to be cost-effective.

Wound, pressure ulcer and burn guidelines - 2: Guidelines for the diagnosis and treatment of pressure ulcers, second edition.

Wound, pressure ulcer and burn guidelines - 2: Guidelines for the diagnosis and treatment of pressure ulcers, second edition.