Effectiveness of using a new polyurethane foam multi‐layer dressing in the sacral area to prevent the onset of pressure ulcer in the elderly with hip fractures: A pragmatic randomised controlled trial

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Abstract

Hip fractures in the elderly are a serious problem for the health service due to the high rate of complications. One of these complications is pressure ulcers that, according to the literature, occur in 8.8% to 55% of patients and mainly arise in the sacral area. The present randomised controlled trial tests whether applying a new innovative multi‐layer polyurethane foam dressing (ALLEVYN LIFE™), reduces the onset of pressure ulcers in the sacral area. From March to December 2016, 359 fragility hip fracture patients were randomly divided into 2 groups: 182 in the control group and 177 in the experimental group. Pressure ulcers occurred overall in 36 patients (10%): 8 patients (4.5%) in the experimental group compared to 28 (15.4%) in the control group: P = 0.001, relative risk 0.29 (95% CI 0.14‐0.61) with NNT of 9 (95% CI 6‐21). In the experimental group the onset of pressure ulcers occurred on average on the 6th day compared to the 4th day in the control group (HR 4.4). Using polyurethane foam is effective at reducing the rate of pressure ulcers in the sacrum in elderly patients with hip fracture. The adhesiveness of this device also enables costs to be kept down.

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Most cited references 33

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G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences

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G*Power (Erdfelder, Faul, & Buchner, 1996) was designed as a general stand-alone power analysis program for statistical tests commonly used in social and behavioral research. G*Power 3 is a major extension of, and improvement over, the previous versions. It runs on widely used computer platforms (i.e., Windows XP, Windows Vista, and Mac OS X 10.4) and covers many different statistical tests of the t, F, and chi2 test families. In addition, it includes power analyses for z tests and some exact tests. G*Power 3 provides improved effect size calculators and graphic options, supports both distribution-based and design-based input modes, and offers all types of power analyses in which users might be interested. Like its predecessors, G*Power 3 is free.

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Pedro Pancorbo-Hidalgo, Francisco Pedro García-Fernández, Isabel Ma Lopez-Medina … (2006)

This paper reports a systematic review conducted to determine the effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice, degree of validation of risk assessment scales, and effectiveness of risk assessment scales as indicators of risk of developing a pressure ulcer. Pressure ulcers are an important health problem. The best strategy to avoid them is prevention. There are several risk assessment scales for pressure ulcer prevention which complement nurses' clinical judgement. However, some of these have not undergone proper validation. A systematic bibliographical review was conducted, based on a search of 14 databases in four languages using the keywords pressure ulcer or pressure sore or decubitus ulcer and risk assessment. Reports of clinical trials or prospective studies of validation were included in the review. Thirty-three studies were included in the review, three on clinical effectiveness and the rest on scale validation. There is no decrease in pressure ulcer incidence was found which might be attributed to use of an assessment scale. However, the use of scales increases the intensity and effectiveness of prevention interventions. The Braden Scale shows optimal validation and the best sensitivity/specificity balance (57.1%/67.5%, respectively); its score is a good pressure ulcer risk predictor (odds ratio = 4.08, CI 95% = 2.56-6.48). The Norton Scale has reasonable scores for sensitivity (46.8%), specificity (61.8%) and risk prediction (OR = 2.16, CI 95% = 1.03-4.54). The Waterlow Scale offers a high sensitivity score (82.4%), but low specificity (27.4%); with a good risk prediction score (OR = 2.05, CI 95% = 1.11-3.76). Nurses' clinical judgement (only considered in three studies) gives moderate scores for sensitivity (50.6%) and specificity (60.1%), but is not a good pressure ulcer risk predictor (OR = 1.69, CI 95% = 0.76-3.75). There is no evidence that the use of risk assessment scales decreases pressure ulcer incidence. The Braden Scale offers the best balance between sensitivity and specificity and the best risk estimate. Both the Braden and Norton Scales are more accurate than nurses' clinical judgement in predicting pressure ulcer risk.

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Author and article information

Contributors

Cristiana Forni:

ORCID: http://orcid.org/0000-0003-4611-9261

cristiana.forni@ior.it

Journal

Journal ID (nlm-ta): Int Wound J

Journal ID (iso-abbrev): Int Wound J

Journal ID (doi): 10.1111/(ISSN)1742-481X

Journal ID (publisher-id): IWJ

Title: International Wound Journal

Publisher: Blackwell Pubishing Ltd (Oxford, UK )

ISSN (Print): 1742-4801

ISSN (Electronic): 1742-481X

Publication date (Electronic): 04 January 2018

Publication date Collection: June 2018

Volume: 15

Issue: 3 ( doiID: 10.1111/iwj.2018.15.issue-3 )

Pages: 383-390

Affiliations

[ ¹ ] Research Nursing Unit Rizzoli Orthopaedic Institute Bologna Italy

[ ² ] Nursing Department Rizzoli Orthopaedic Institute Bologna Italy

Author notes

[*] [* ] Correspondence

C Forni, RN, MA, Research Nursing Unit, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna, Italy. Email: cristiana.forni@ 123456ior.it

Author information

Cristiana Forni http://orcid.org/0000-0003-4611-9261

Article

Publisher ID: IWJ12875

DOI: 10.1111/iwj.12875

PMC ID: 7950011

PubMed ID: 29314659

SO-VID: 2e1e5f44-a285-4034-af82-641dbf07bf6a

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.