Tricco Andrea C, Antony Jesmin, Vafaei Afshin, Khan Paul A, Harrington Alana, Cogo Elise, Wilson Charlotte, Perrier Laure, Hui Wing, Straus Sharon E
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada.
Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
BMC Med. 2015 Apr 22;13:89. doi: 10.1186/s12916-015-0288-5.
Numerous, often multi-faceted regimens are available for treating complex wounds, yet the evidence of these interventions is recondite across the literature. We aimed to identify effective interventions to treat complex wounds through an overview of systematic reviews.
MEDLINE (OVID interface, 1946 until October 26, 2012), EMBASE (OVID interface, 1947 until October 26, 2012), and the Cochrane Database of Systematic Reviews (Issue 10 of 12, 2012) were searched on October 26, 2012. Systematic reviews that examined adults receiving care for their complex wounds were included. Two reviewers independently screened the literature, abstracted data, and assessed study quality using the Assessment of Multiple Systematic Reviews (AMSTAR) tool.
Overall, 99 systematic reviews were included after screening 6,200 titles and abstracts and 422 full-texts; 54 were systematic reviews with a meta-analysis (including data on over 54,000 patients) and 45 were systematic reviews without a meta-analysis. Overall, 44% of included reviews were rated as being of high quality (AMSTAR score ≥ 8). Based on data from systematic reviews including a meta-analysis with an AMSTAR score ≥ 8, promising interventions for complex wounds were identified. These included bandages or stockings (multi-layer, high compression) and wound cleansing for venous leg ulcers; four-layer bandages for mixed arterial/venous leg ulcers; biologics, ultrasound, and hydrogel dressings for diabetic leg/foot ulcers; hydrocolloid dressings, electrotherapy, air-fluidized beds, and alternate foam mattresses for pressure ulcers; and silver dressings and ultrasound for unspecified mixed complex wounds. For surgical wound infections, topical negative pressure and vacuum-assisted closure were promising interventions, but this was based on evidence from moderate to low quality systematic reviews.
Numerous interventions can be utilized for patients with varying types of complex wounds, yet few treatments were consistently effective across all outcomes throughout the literature. Clinicians and patients can use our results to tailor effective treatment according to type of complex wound. Network meta-analysis will be of benefit to decision-makers, as it will permit multiple treatment comparisons and ranking of the effectiveness of all interventions. Please see related article: http://dx.doi.org/10.1186/s12916-015-0326-3.
有许多通常多方面的治疗方案可用于治疗复杂伤口，但这些干预措施的证据在文献中晦涩难懂。我们旨在通过系统评价的概述来确定治疗复杂伤口的有效干预措施。
2012年10月26日检索了MEDLINE（OVID界面，1946年至2012年10月26日）、EMBASE（OVID界面，1947年至2012年10月26日）和Cochrane系统评价数据库（2012年第10期，共12期）。纳入了对接受复杂伤口护理的成年人进行研究的系统评价。两名评价者独立筛选文献、提取数据，并使用多重系统评价评估（AMSTAR）工具评估研究质量。
总体而言，在筛选了6200篇标题和摘要以及422篇全文后，共纳入99篇系统评价；54篇是进行了荟萃分析的系统评价（包括超过54000名患者的数据），45篇是未进行荟萃分析的系统评价。总体而言，44%的纳入评价被评为高质量（AMSTAR评分≥8）。基于包括AMSTAR评分≥8的荟萃分析的系统评价数据，确定了对复杂伤口有前景的干预措施。这些措施包括用于下肢静脉溃疡的绷带或长袜（多层、高压力）以及伤口清洁；用于下肢动静脉混合溃疡的四层绷带；用于糖尿病下肢/足部溃疡的生物制品、超声和水凝胶敷料；用于压疮的水胶体敷料、电疗法、气悬浮床和交替泡沫床垫；以及用于未明确的混合复杂伤口的银敷料和超声。对于手术伤口感染，局部负压和真空辅助闭合是有前景的干预措施，但这是基于质量从中等到低的系统评价证据。
有许多干预措施可用于不同类型复杂伤口的患者，但在整个文献中，很少有治疗方法在所有结局上都始终有效。临床医生和患者可以利用我们的结果根据复杂伤口的类型定制有效的治疗方案。网状荟萃分析将对决策者有益，因为它将允许进行多种治疗比较并对所有干预措施的有效性进行排名。请参阅相关文章：http://dx.doi.org/10.1186/s12916-015-0326-3。
