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Pressure ulcer management: what is the evidence?
Steven M. Levine, M.D., Jamie P. Levine, M.D., Pierre B. Saadeh, M.D..
NYU Langone Medical Center, New York, NY, USA.
Pressure ulcers cost the US healthcare over $11 Billion annually and their incidence is continuing to rise with an aging population. Since new CMS regulations in 2008 began penalizing hospitals for pressure ulcers that develop as in-patients and increased reimbursement for pre-existing pressure ulcers, hospitals have a strong economic incentive to prevent and adequately treat this condition. Increasing the dilemma is the fact that CMS will only pay for measures to prevent or treat pressure ulcers that have high levels of evidence to justify their use.
For this reason, the authors reviewed all available level I and II data related to pressure ulcer care in order to develop a completely evidence-based algorithm for use in the hospital setting. We searched MEDLINE, EMBASE, Cochrane, and EBSCO databases for all level I and II evidence related to pressure ulcer care or treatment, including wound cleansing, patient repositioning strategies, negative pressure therapy, specialized mattress interventions, methods of debridement, ultrasound therapy, flap closure, parenteral feeding, and postoperative sitting protocols.
Our results demonstrated that wound cleansing, parenteral feeding, specialized mattress interventions, and some local wound modalities are supported by level I and II studies. However, negative pressure therapy, methods of debridement, and ultrasound were examined in level I and II studies and not demonstrated to be beneficial. Other interventions such patient repositioning, flap closure, and postoperative sitting protocols had no high level data to influence their care delivery.
Our results demonstrated that some interventions we expected to be supported by high levels of evidence were not, and the opposite was true as well. This type of critical analysis allows hospitals to develop evidence-based protocols for pressure ulcer management, and directs clinicians to areas that are in need of well-designed research studies.
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