By Temple University School of Podiatric Medicine Journal Review Club

Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

Article: Prevalence of Pressure Ulcers in Long-Term Care: A Global Review.

Authors: Anthony D, Alosoumi D, Safari R

Journal: J Wound Care. 2019;28(11):702-709. doi: 10.12968/jowc.2019.28.11.702

Reviewed by: Michaela Pagano, class of 202X , Temple University School of Podiatric Medicine

Introduction

Pressure injuries (PIs) are prevalent in facilities where many of the patients are bedridden or confined to a wheelchair. PIs, also referred to as pressure ulcers or even bedsores, are caused by insufficient blood circulation to areas that are exposed to unrelieved, prolonged pressure. PIs are staged using the National Pressure Injury Advisory Panel (NPIAP) staging system as stages 1 to 4, based on their severity.¹

Throughout the paper, the authors referred to PI as pressure ulcer, which is the older terminology. The authors of this study reported that the last published review on the prevalence of PIs in long-term care facilities was in 1995. According to the authors of the current article, “before a problem can be addressed, it has to be acknowledged.” The intent of this study was to conduct a full systematic review. However, given the aforementioned lack of recognition in the medical community, there was an insufficient amount of information available to tackle the topic. What little information that does exist is primarily concerned with the treatment of PIs, not the prevalance. Therefore, a narrative review of a previous systematic review was completed instead.

Pressure Ulcer/Injury Prevention: Assessing Risk Factors

Methods

The examiners used suggested instructions from the PRISMA statement (Preferred Reporting Items for Systematic reviews and Meta-Analyses). This review focused on the prevalence and incidence of PIs, where and when PIs occur, and the demographics (sex, age, ethnicity) of affected patients. The databases used to gain research on the matter included Medline, Embase, and CINAHL. Papers were evaluated using the Joanna Briggs Institute Critical Appraisal Instrument for Studies Reporting Prevalence Data and the Joanna Briggs Institute Data Extraction Form for Prevalence and Incidence Studies. Prevalence and incidence are reported with a 95% confidence interval.

To be included in the study, papers had to have an abstract, a date of publication of 2000 or later, and inclusion of data from a complete head to toe physical examination. Studies that were not included were those with a “moderate” or “high” risk of bias, those that did not report prevalence or incidence, and those that did not include sample size. Based on these inclusion criteria, of the original 815 references, the study used a total of 17 references for this review.

Results

The results showed that the prevalence of PIs varied greatly among different countries. For example, in one reference taken from the Netherlands, there was a 32.4% prevalence of PIs in a long-term care facility ranging from stages 1 to 4, whereas in another reference from Germany, the prevalence was only 3.4%. Many of the 17 references used in the study did not stage the ulcers, thus emphasizing the need for better record keeping and future research.

Conclusion

Compared with the systematic review that this narrative review was based on, there seems to be little progress in PI prevention. The PI prevalence in the 1995 review ranged from 7% to 23% and was comparable to the prevalence in the 17 references considered in this 2019 review. PIs continue to be a problem in long-term care facilities, and many modern countries still have no published data on this topic. There is certainly a need to continue to conduct studies on PI prevalence. Based on this study, the examiners have applied for funding to continue their research.

Reference

1. Edsberg L, Black J, Goldberg M, et.al. Revised National Pressure Ulcer Advisory Panel pressure injury staging system. J Wound Ostomy Continence Nurs. 2016;43(6):585-597. doi: 10.1097/WON.0000000000000281.

About The Author

Michaela Pagano is a first year podiatric medical student at Temple University School of Podiatric Medicine (TUSPM) in Philadelphia, Pennsylvania. She graduated from The Pennsylvania State University in State College, Pennsylvania in 2018 with a Bachelor of Science in Biology. In college, Michaela was very involved in research in the Biobehavioral Health School at Penn State where she led nutritional programs for preschoolers and collected and analyzed data from correlating cardiac studies. Michaela has always been interested in the medical field but found podiatry as a freshman in college and really appreciated the variety that can be had within the profession. In the fall of 2019, she matriculated at TUSPM with a merit scholarship. She is currently the first year liaison for the wound care club and plans on getting more involved in the club as she continues at TUSPM. As a first year, she doesn’t know specifically what areas of podiatry she is most interested in but has enjoyed the beginning of her studies thus far. Dr. James McGuire is the director of the Leonard S. Abrams Center for Advanced Wound Healing and an associate professor of the Department of Podiatric Medicine and Orthopedics at the Temple University School of Podiatric Medicine in Philadelphia.