Cath Lab Digest

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Abstract

  Although difficult to quantify due to methodological variations, the worldwide burden of pressure ulcers (PUs) is substantial. Recognizing the importance of providing evidence-based care to help reduce this burden, the North American Wound Care Council societies collaborated to identify PU research and education opportunities using the PU “Guideline of Guidelines” developed and tested by Association for the Advancement of Wound Care Guideline Department (AAWC GD). Volunteer AAWC GD members compiled recommendations from PU guidelines available in 2008, searched the literature for additional research as needed, and developed evidence levels for all recommendations using an established level-of-evidence rating scheme. At the same time, AAWC members and Ostomy Wound Management readers were invited via email to participate in a content validation study of the 368 recommendations, rating items on a scale of 1 (not relevant) to 4 (very relevant and succinct). Items with a content validity index (CVI) >0.75 were considered valid. Recommendations with support from two or more randomized controlled PU trials or two or more cohort studies for diagnostic or predictive validity (A-level evidence) and a CVI >75 were grouped as ready for implementation. Recommendations with content validity but without A-level evidence were determined to be opportunities for research; recommendations that lacked content validity but that had A-level evidence were viewed as opportunities for education. Thirty-two (32) multidisciplinary healthcare professionals participated in the content validation study. Most (93.2%) recommendations were rated as valid. Of the 97 (26%) recommendations with A-level evidence, 90 (24.5% of total) met both strong content validity and strong evidence criteria and were rated as ready for implementation as standard of care. Most recommendations (253, 68.8%) were rated as valid but had B- or C-level evidence, representing opportunities for research. Only seven (1.9%) recommendations had a low CVI but A-level evidence, suggesting a need for education. The results show that most of the guideline recommendations are valid, that the number of PU intervention recommendations with A-level evidence is increasing, but that, in general, the need for research to replace opinion with evidence remains high across the entire spectrum of PU prevention and treatment. Understanding what is known (recommendation: ready to implement), what is not known (research needed), and what clinicians need to know (education needed) is an important step toward reducing the burden of pressure ulcers.

Keywords: pressure ulcer, guideline of care, evidence levels, content validity, education, research

Index: Ostomy Wound Management 2011;57(11):22–35

Potential Conflicts of Interest: Joyce Black has received speaker honoraria, served as a consultant or paid advisory board member, and/or received research grants from Cardinal Health (Dublin, OH), Celleration Inc. (Eden Prairie, MN), Coloplast Corp, (Minneapolis, MN), Hill-Rom (Batesville, IN), KCI (San Antonio, TX), Mölnlycke Health Care (Norcross, GA), and Sage Products, Inc. (Cary, IL). Additional author disclosures appear at the end of this article.

Economic, Social, and Clinical Burden of Pressure Ulcers

  Pressure ulcer (PU) prevalence, incidence, and cost reporting methods vary across different healthcare systems, so the true magnitude of the global burden of PU is difficult to estimate.