Lovegrove Josephine, Fulbrook Paul, Miles Sandra J, Steele Michael
School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland 4014, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland 4032, Australia.
School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland 4014, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Rode Road, Chermside, Queensland 4032, Australia; Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Johannesburg 2000, South Africa.
Int J Nurs Stud. 2021 Oct;122:104027. doi: 10.1016/j.ijnurstu.2021.104027. Epub 2021 Jun 30.
Hospital-acquired pressure injuries cause significant harm to afflicted individuals, and financially burden hospitals. Most pressure injuries are avoidable with the use of preventative interventions. However, within acute hospital settings the effectiveness of pressure injury preventative interventions, as demonstrated by high-level evidence, requires examination.
Analyse the effectiveness of interventions to prevent pressure injury in adults admitted to acute hospital settings.
Systematic review and meta-analysis of randomised controlled trials.
CINAHL, MEDLINE, Scopus, Web of Science and Embase were searched in May/June 2019. In April 2020, searches were updated to the end of 2019.
Randomised controlled trials which investigated the effectiveness of pressure injury preventative interventions on pressure injury incidence, within adults admitted to acute hospital settings, were included. Trials limited to pressure injury treatment or specialty areas, and non-English reports, were excluded. Screening, extraction and risk-of-bias assessment were undertaken independently by two reviewers, with a third as arbitrator. Included studies were grouped by intervention type. Studies were synthesised narratively, and meta-analysis was undertaken where study interventions were similar. Using a random-effects model, primary meta-analyses were undertaken using intention-to-treat data.
Of 2000 records, 45 studies were included in the systematic review which investigated nine different intervention types: continence management, heel protection devices, medication, nutrition, positioning, prophylactic dressings, support surfaces, topical preparations and bundled interventions. All studies were judged to be at unclear or high risk-of-bias. Several meta-analyses were undertaken, pooled by intervention type. Most pooled samples were heterogeneous. Based on intention-to-treat data, only one intervention demonstrated a statistically significant effect: Australian medical sheepskin surfaces compared to other standard care surfaces (risk ratio 0.42, p = 0.006, I = 36%), but included studies were limited by bias and age. Following per protocol meta-analyses, only two intervention types demonstrated a significant effect: support surfaces (active versus other comparison [risk ratio = 0.54, p = 0.005, I = 43%] and standard surfaces [risk ratio = 0.31, p < 0.001, I = 0%]; and reactive versus other comparison surfaces [risk ratio = 0.53, p = 0.03, I = 64%]) and heel protection devices versus standard care (risk ratio = 0.38, p < 0.001, I = 36%).
Only one intervention was supported by intention-to-treat meta-analysis. Significantly, all trials were at unclear or high risk-of-bias; and there were several limitations regarding heterogeneity across trials and trial outcomes. Further large-scale, high-quality trials testing pressure injury preventative interventions are required to establish effectiveness within acute hospital settings. Attention should be paid to true intention-to-treat analysis, and acute and intensive care settings should be reported separately. PROSPERO registration number:CRD42019129556.
医院获得性压疮会给患者造成严重伤害，并给医院带来经济负担。大多数压疮通过采取预防措施是可以避免的。然而，在急性医院环境中，高级别证据所证明的压疮预防措施的有效性需要进行检验。
分析针对入住急性医院的成年人预防压疮干预措施的有效性。
对随机对照试验进行系统评价和荟萃分析。
2019年5月/6月检索了CINAHL、MEDLINE、Scopus、Web of Science和Embase数据库。2020年4月，检索更新至2019年底。
纳入调查针对入住急性医院的成年人采取的压疮预防措施对压疮发生率有效性的随机对照试验。排除仅限于压疮治疗或专科领域的试验以及非英文报告。由两名评价员独立进行筛选、提取和偏倚风险评估，第三名评价员作为仲裁人。纳入研究按干预类型分组。对研究进行叙述性综合分析，对于研究干预措施相似的情况进行荟萃分析。采用随机效应模型，使用意向性分析数据进行主要荟萃分析。
在2000条记录中，45项研究纳入系统评价，这些研究调查了9种不同的干预类型：失禁管理、足跟保护装置、药物、营养、体位摆放、预防性敷料、支撑面、局部用药制剂和综合干预措施。所有研究被判定为偏倚风险不明确或高风险。按干预类型进行了多项荟萃分析。大多数汇总样本存在异质性。基于意向性分析数据，只有一种干预措施显示出统计学显著效果：与其他标准护理支撑面相比，澳大利亚医用羊皮支撑面（风险比0.42，p = 0.006，I² = 36%），但纳入研究受偏倚和年龄限制。按照符合方案荟萃分析，只有两种干预类型显示出显著效果：支撑面（主动支撑面与其他对照[风险比 = 0.54，p = 0.005，I² = 43%]和标准支撑面[风险比 = 0.31，p < 0.001，I² = 0%]；反应性支撑面与其他对照支撑面[风险比 = 0.53，p = 0.03，I² = 64%]）以及足跟保护装置与标准护理（风险比 = 0.38，p < 0.001，I² = 36%）。
意向性分析荟萃分析仅支持一种干预措施。值得注意的是，所有试验的偏倚风险均不明确或为高风险；并且在试验间的异质性和试验结果方面存在若干局限性。需要进一步开展大规模、高质量试验来检验压疮预防措施在急性医院环境中的有效性。应关注真正的意向性分析，并且急性和重症监护环境应分别报告。PROSPERO注册号：CRD42019129556。
