primary outcome:
Risk assessment tools for the prevention of pressure ulcers
The proportion of participants developing new pressure ulcers of any grade, within the study period. For the purpose of this review a pressure ulcer was defined as a localised injury to the skin or underlying tissue (or both), usually over a bony prominence, as a result of pressure, or pressure in combination with shear (NPUAP/EPUAP/PPPIA 2014).Following delivery of the training to the staff, one study enrolled 150 participants with a Braden score of 18 or less, from six wards (Saleh 2009). Seventy‐four participants were in the Braden scale group (Group A), and 76 were in the training group (Group B). We are uncertain if Braden pressure ulcer risk assessment and training, compared with pressure ulcer risk assessment using clinical judgement and training, makes any difference to pressure ulcer incidence (Braden group: 22%, n = 16/74; training group: 22%, n = 17/76; risk ratio (RR) 0.97, 95% confidence interval (CI) 0.53 to 1.77; very‐low certainty evidence, downgraded twice for serious risk of bias and twice for serious imprecision). Although the outcome is described as pressure ulcer incidence by the study authors, what is reported is the number of people who developed pressure ulcers. (Analysis 1.1; summary of findings Table for the main comparison).Following delivery of the training to the staff, one study enrolled 106 participants from three wards with a Braden score of 18 or less (Saleh 2009). These patients were risk assessed using clinical judgement (Group C). The incidence of pressure ulcers in this clinical judgement group was compared with the 74 participants who were in the Braden scale group (Group A). We are uncertain if Braden pressure ulcer risk assessment and training, compared with pressure ulcer risk assessment using clinical judgement alone, makes any difference to pressure ulcer incidence (Braden group: 22%, n = 16/74; clinical judgement group: 15%, n = 16/106; RR 1.43, 95% CI 0.77 to 2.68; very‐low certainty evidence, downgraded twice for serious risk of bias and twice for serious imprecision). Although the outcome is described as pressure ulcer incidence by the study authors, what is reported is the number of people who developed pressure ulcers. (Analysis 2.1; summary of findings Table 2).One study enrolled 411 participants in the Waterlow group and 410 participants into the group risk assessed using clinical judgement (Webster 2011). Although outcomes are reported as ulcers developed, rather than people developing ulcers, only one ulcer was assessed per person. Risk assessment using the Waterlow pressure ulcer risk assessment tool may make little or no difference to pressure ulcer incidence when compared to risk assessment using clinical judgement (Waterlow group 7.5%, n = 31/411; clinical judgement group: 6.8%, n = 28/410; RR 1.10, 95% CI 0.68 to 1.81; low‐certainty evidence, downgraded once for risk of bias and once for imprecision) (Analysis 3.1; summary of findings Table 3). One study enrolled 410 participants in the Ramstadius group and 410 participants into the group receiving pressure ulcer risk assessment using clinical judgement. Although outcomes are reported as ulcers developed, rather than people developing ulcers, only one ulcer was assessed per person. Risk assessment using the Ramstadius pressure ulcer risk assessment tool may make little or no difference to pressure ulcer incidence when compared to risk assessment using clinical judgement (Ramstadius group: 5.4%, n = 22/410; clinical judgement group: 6.8%, n = 28/410; RR 0.79, 95% CI 0.46 to 1.35; low‐certainty evidence, downgraded once for risk of bias and once for imprecision) (Analysis 4.1; summary of findings Table 4). One study enrolled 411 participants in the Waterlow group and 410 participants in the Ramstadius group (Webster 2011). Although outcomes are reported as ulcers developed, rather than people developing ulcers, only one ulcer was assessed per person. Risk assessment using the Waterlow pressure ulcer risk assessment tool may make little or no difference to pressure ulcer incidence when compared to use of the Ramstadius pressure ulcer risk assessment tool (Waterlow group: 7.5%, n = 31/411; Ramstadius group: 5.4%, n = 22/410; RR 1.41, 95% CI 0.83 to 2.39; low‐certainty evidence, downgraded once for risk of bias and once for imprecision) (Analysis 5.1; summary of findings Table 5).