Risk assessment tools used for preventing pressure ulcers

Moore ZEH, Cowman S

Published Online:

December 8, 2010

Pressure ulcers (also known as bed sores, pressure sores and decubitus ulcers) are areas of localised injury to the skin, underlying tissue or both, usually over a bony prominence, as a result of pressure, or pressure in combination with shear. Pressure ulcers mainly occur in people who have limited mobility, nerve damage or both. Pressure ulcer risk assessment is part of the process used to identify individuals at risk of developing a pressure ulcer. Risk assessments generally use checklists and their use is recommended by pressure ulcer prevention guidelines. This update of the review found one study that was eligible for inclusion. The study found no difference in the number of new pressure ulcers that developed in individuals assessed using structured risk assessment compared with unstructured risk assessment. However, there were methodological limitations with this study. Therefore, to date, very little research has studied the effect of risk assessment and we are unable to draw any firm conclusions.

Abstract (click to read)

Background:

Pressure ulcer risk assessment is a component of the assessment process used to identify individuals at risk of developing a pressure ulcer. Use of a risk assessment tool is recommended by many international pressure ulcer prevention guidelines, however it is not known whether using a risk assessment tool makes a difference to patient outcomes. We conducted a review to clarify the role of pressure ulcer risk assessment in clinical practice.

Objectives:

To determine whether using structured, systematic pressure ulcer risk assessment tools, in any health care setting, reduces the incidence of pressure ulcers.

Search strategy:

For this first update, we searched the Cochrane Wounds Group Specialised Register (searched 21 September 2010); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3); Ovid MEDLINE (2007 to September Week 1 2010); Ovid MEDLINE - In-Process & Other Non-Indexed Citations (September 20, 2010) and Ovid EMBASE (2007 to 2010 Week 37) and EBSCO CINAHL (2007 to 17 September 2010).

Selection criteria:

Randomised controlled trials (RCTs) comparing the use of structured, systematic, pressure ulcer risk assessment tools with no structured pressure ulcer risk assessment, or with unaided clinical judgement, or RCTs comparing the use of different structured pressure ulcer risk assessment tools.

Data collection and analysis:

Two review authors independently assessed titles and abstracts of the studies identified by the search strategy for eligibility, obtained full versions of potentially relevant studies and screened these against the inclusion criteria.

Main results:

For the original review, no studies were identified that met the inclusion criteria. For this first update, we identified and included one small, cluster randomised study. The study included 256 people randomised by ward into three groups in which the methods of risk assessment were: the Braden pressure ulcer risk assessment tool and training; unstructured risk assessment and training; and unstructured risk assessment alone. There was no statistically significant difference between the groups in terms of pressure ulcer incidence however the study was underpowered to detect a clinically important difference in pressure ulcer incidence.

Authors' conclusions:

One small RCT was identified which evaluated the effect of risk assessment on patient outcomes; there was no statistically significant difference in pressure ulcer incidence between patients who were assessed using structured risk assessment compared with those receiving unstructured risk assessment. Methodological limitations of this study prevent firm conclusions regarding whether the use of structured, systematic pressure ulcer risk assessment tools, in any healthcare setting, reduces the incidence of pressure ulcers. The effect of structured risk assessment tools on pressure ulcer incidence needs to be evaluated.

This record should be cited as:

Moore ZEH, Cowman S. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006471. DOI: 10.1002/14651858.CD006471.pub2

Assessed as up to date:

November 8, 2010

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Wounds Group

Health topics:

Skin > Ulcers: pressure > Prevention

Wounds > Ulcers: pressure > Prevention

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Risk assessment tools used for preventing pressure ulcers

More like this

Copyright © 2011 - The Cochrane Collaboration