Honaker Jeremy S, Forston Michael R, Davis Emily A, Weisner Michelle M, Morgan Jennifer A, Sacca Emily
Department of Dermatology, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
Department of Rehabilitative Services, Baptist Health Lexington, Lexington, Kentucky.
Wound Repair Regen. 2016 Nov;24(6):1081-1088. doi: 10.1111/wrr.12479. Epub 2016 Nov 21.
The optimal treatment for deep tissue pressure injuries has not been determined. Deep tissue pressure injuries represent a more ominous early stage pressure injury that may evolve into full thickness ulceration despite implementing the standard of care for pressure injury. A longitudinal prospective historical case control study design was used to determine the effectiveness of noncontact low frequency ultrasound plus standard of care (treatment group) in comparison to standard of care (control group) in reducing deep tissue pressure injury severity, total surface area, and final pressure injury stage. The Honaker Suspected Deep Tissue Injury Severity Scale (range 3-18[more severe]) was used to determine deep tissue pressure injury severity at enrollment (Time 1) and discharge (Time 2). A total of 60 subjects (Treatment = 30; Control= 30) were enrolled in the study. In comparison to the control group mean deep tissue pressure injury total surface area change at Time 2 (0.3 cm ), the treatment group had a greater decrease (8.8 cm ) that was significant (t = 2.41, p = 0.014, r = 0.10). In regards to the Honaker Suspected Deep Tissue Injury Severity Scale scores, the treatment group had a significantly lower score (7.6) in comparison to the control group (11.9) at time 2, with a mean difference of 4.6 (t = 6.146, p = 0.0001, r = 0.39). When considering the final pressure ulcer stage at Time 2, the control group were mostly composed of unstageable pressure ulcer (57%) and deep tissue pressure injury severity (27%). In contrast, the treatment group final pressure ulcer stages were less severe and were mostly composed of stage 2 pressure injury (50%) and deep tissue pressure injury severity (23%) were the most common at time 2. The results of this study have shown that deep tissue pressure injury severity treated with noncontact low frequency ultrasound within 5 days of onset and in conjunction with standard of care may improve outcomes as compared to standard of care only.
深部组织压力性损伤的最佳治疗方法尚未确定。深部组织压力性损伤是一种更严重的早期压力性损伤，尽管实施了压力性损伤的标准护理措施，但仍可能发展为全层溃疡。本研究采用纵向前瞻性历史对照研究设计，以确定非接触式低频超声联合标准护理（治疗组）与标准护理（对照组）相比，在降低深部组织压力性损伤的严重程度、总表面积和最终压力性损伤分期方面的有效性。使用霍纳克疑似深部组织损伤严重程度量表（范围为3 - 18[更严重]）来确定入组时（时间1）和出院时（时间2）的深部组织压力性损伤严重程度。共有60名受试者（治疗组 = 30；对照组 = 30）参与了本研究。与对照组在时间2时深部组织压力性损伤总表面积的平均变化（0.3平方厘米）相比，治疗组有更大幅度的减少（8.8平方厘米），差异具有统计学意义（t = 2.41，p = 0.014，r = 0.10）。关于霍纳克疑似深部组织损伤严重程度量表评分，治疗组在时间2时的得分（7.6）显著低于对照组（11.9），平均差异为4.6（t = 6.146，p = 0.0001，r = 0.39）。在考虑时间2时的最终压疮分期时，对照组主要为不可分期的压疮（57%）和深部组织压力性损伤严重程度（27%）。相比之下，治疗组的最终压疮分期较轻，在时间2时主要为2期压力性损伤（50%）和深部组织压力性损伤严重程度（23%）最为常见。本研究结果表明，与仅采用标准护理相比，在发病5天内采用非接触式低频超声联合标准护理治疗深部组织压力性损伤，可能会改善预后。
