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Graves N, Phillips CJ, Harding K. A narrative review of the epidemiology and economics of chronic wounds. Br J Dermatol 2021; 187:141-148. [PMID: 34549421 DOI: 10.1111/bjd.20692] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 12/11/2022]
Abstract
Chronic wounds have a debilitating effect on the quality of life of many individuals, and the large economic impact on health system budgets warrants greater attention in policy making and condition management than is currently evident. The aim of this narrative review is to summarize the nature and extent of the chronic wound problem that confronts health systems across the world. The first section is used to highlight the underlying epidemiology relating to chronic wounds, while the second explores the economic costs associated with them and the relative efficiency of measures designed to manage them.
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Affiliation(s)
- N Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - C J Phillips
- Department of Public Health and Policy Studies, Swansea University, Swansea, UK
| | - K Harding
- Clinical Innovation Hub, Cardiff University, Cardiff, UK
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Olsson M, Järbrink K, Divakar U, Bajpai R, Upton Z, Schmidtchen A, Car J. The humanistic and economic burden of chronic wounds: A systematic review. Wound Repair Regen 2018; 27:114-125. [DOI: 10.1111/wrr.12683] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/28/2018] [Accepted: 10/15/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Maja Olsson
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine; Nanyang Technological University; Singapore Singapore
| | - Krister Järbrink
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine; Nanyang Technological University; Singapore Singapore
| | - Ushashree Divakar
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine; Nanyang Technological University; Singapore Singapore
| | - Ram Bajpai
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine; Nanyang Technological University; Singapore Singapore
| | - Zee Upton
- Institute of Medical Biology, Agency for Science; Technology and Research (A*STAR); Singapore Singapore
- Dermatology and Skin Biology Programme, Lee Kong Chian School of Medicine; Nanyang Technological University; Singapore Singapore
| | - Artur Schmidtchen
- Dermatology and Skin Biology Programme, Lee Kong Chian School of Medicine; Nanyang Technological University; Singapore Singapore
- Division of Dermatology, Department of Clinical Sciences; Lund University; Lund Sweden
| | - Josip Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine; Nanyang Technological University; Singapore Singapore
- Global eHealth Unit, Department of Primary Care and Public Health; School of Public Health, Imperial College London; London United Kingdom
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White BA, Dea N, Street JT, Cheng CL, Rivers CS, Attabib N, Kwon BK, Fisher CG, Dvorak MF. The Economic Burden of Urinary Tract Infection and Pressure Ulceration in Acute Traumatic Spinal Cord Injury Admissions: Evidence for Comparative Economics and Decision Analytics from a Matched Case-Control Study. J Neurotrauma 2017; 34:2892-2900. [DOI: 10.1089/neu.2016.4934] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Nicolas Dea
- Service de Neurochirurgie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - John T. Street
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Najmedden Attabib
- Dalhousie University, Halifax, Nova Scotia; Horizon Health Network, Division of Neurosurgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G. Fisher
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel F. Dvorak
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Martinez‐Zapata MJ, Martí‐Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L, Garcia J, Zaror C. Autologous platelet-rich plasma for treating chronic wounds. Cochrane Database Syst Rev 2016; 2016:CD006899. [PMID: 27223580 PMCID: PMC9308064 DOI: 10.1002/14651858.cd006899.pub3] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Autologous platelet-rich plasma (PRP) is a treatment that contains fibrin and high concentrations of growth factors with the potential to improve the healing of chronic wounds. This is the first update of a review first published in 2012. OBJECTIVES To determine whether autologous PRP promotes the healing of chronic wounds. SEARCH METHODS In June 2015, for this first update, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library): Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. We also searched for ongoing and unpublished clinical trials in the WHO International Clinical Trials Registry Platform (ICTRP) (searched January 2015). We did not impose any restrictions with respect to language, date of publication, or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared autologous PRP with placebo or alternative treatments for any type of chronic wound in adults. We did not apply any date or language restrictions. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology, including two reviewers independently selecting studies for inclusion, extracting data, and assessing risk of bias. MAIN RESULTS The search identified one new RCT, making a total of 10 included RCTs (442 participants, 42% women). The median number of participants per RCT was 29 (range 10 to 117). Four RCTs recruited people with a range of chronic wounds; three RCTs recruited people with venous leg ulcers, and three RCTs considered foot ulcers in people with diabetes. The median length of treatment was 12 weeks (range 8 to 40 weeks).It is unclear whether autologous PRP improves the healing of chronic wounds generally compared with standard treatment (with or without placebo) (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.95 to 1.50; I(2) = 27%, low quality evidence, 8 RCTs, 391 participants). Autologous PRP may increase the healing of foot ulcers in people with diabetes compared with standard care (with or without placebo) (RR 1.22, 95% CI 1.01 to 1.49; I(2) = 0%, low quality evidence, 2 RCTs, 189 participants). It is unclear if autologous PRP affects the healing of venous leg ulcers (RR 1.02, 95% CI 0.81 to 1.27; I(2) = 0% ). It is unclear if there is a difference in the risk of adverse events in people treated with PRP or standard care (RR 1.05, 95% CI 0.29 to 3.88; I(2) = 0%, low quality evidence from 3 trials, 102 participants). AUTHORS' CONCLUSIONS PRP may improve the healing of foot ulcers associated with diabetes, but this conclusion is based on low quality evidence from two small RCTs. It is unclear whether PRP influences the healing of other chronic wounds. The overall quality of evidence of autologous PRP for treating chronic wounds is low. There are very few RCTs evaluating PRP, they are underpowered to detect treatment effects, if they exist, and are generally at high or unclear risk of bias. Well designed and adequately powered clinical trials are needed.
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Affiliation(s)
- Maria José Martinez‐Zapata
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 167Pavilion 18BarcelonaCatalunyaSpain08025
| | | | - Ivan Solà
- CIBER Epidemiología y Salud Pública (CIBERESP) ‐ Universitat Autònoma de BarcelonaIberoamerican Cochrane Centre ‐ Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 167Pavilion 18BarcelonaCatalunyaSpain08025
| | - José Angel Expósito
- Agency for Health Quality and Assessment of Catalonia (AQuAS)Roc Boronat, 81‐95BarcelonaCataloniaSpain08805
| | - Ignasi Bolíbar
- Hospital de la Santa Creu i Sant PauEpidemiología Clínica y Salud PúblicaSant Antoni Maria Claret 171Edifici Casa de ConvalescènciaBarcelonaCatalunyaSpain08041
| | - Luciano Rodríguez
- Banc de Sang i TeixitsTissue BankPasseig Taulat 106‐116BarcelonaCatalunyaSpain080035
| | - Joan Garcia
- Departament de Salut. Generalitat de CatalunyaCentre de Teixits i Teràpia CellularAutovia de Castelldedels, Km 2.7L'Hospitalet de LLobregatBarcelonaCatalunyaSpain08907
| | - Carlos Zaror
- Faculty of Dentistry, Universidad de la FronteraDepartment of Pediatric Dentistry and OrthodonticTemucoChile
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Chopra T, Marchaim D, Awali RA, Levine M, Sathyaprakash S, Chalana IK, Ahmed F, Martin ET, Sieggreen M, Sobel JD, Kaye KS. Risk factors and acute in-hospital costs for infected pressure ulcers among gunshot-spinal cord injury victims in southeastern Michigan. Am J Infect Control 2016; 44:315-9. [PMID: 26619947 DOI: 10.1016/j.ajic.2015.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Management of pressure ulcers (PrUs) in patients with gunshot-spinal cord injuries (SCIs) presents unique medical and economic challenges for practitioners. METHODS A retrospective chart review was conducted at 3 acute care hospitals in metropolitan Detroit for patients admitted with PrUs due to gunshot-SCIs between January 2004 and December 2008. Multivariate analysis using logistic regression was conducted to choose for the independent predictors of infected PrUs. Mean adjusted in-hospital costs per patient and per hospitalization were calculated and compared between infected and noninfected PrUs. RESULTS The study cohort included 201 gunshot-SCI patients with PrUs contributing to 395 admissions, including readmissions, between 2004 and 2008. Seventy-six patients (38%) had infected PrUs at time of the index admission. Independent predictors of infected PrUs on index admission included Charlson Comorbidity Index ≥2 (odds ratio, 2.18, P = .026) and stage III/IV PrU (odds ratio, 4.82; P <.0001). During the study period, the cumulative median duration of hospitalization per patient was 12 days (interquartile range, 6-24 days), resulting in a mean adjusted cost of $19,969 ± $6639 per patient. The mean adjusted cost per hospitalization for patients with infected PrUs was significantly higher than that for patients with noninfected PrUs ($16,735 ± $8310 vs $12,356 ± $7007; P <.001). CONCLUSIONS A multidisciplinary approach including home-based rehabilitation programs and SCI wound clinics might help prevent PrUs and their complications and reduce associated costs.
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The cost of prevention and treatment of pressure ulcers: A systematic review. Int J Nurs Stud 2015; 52:1754-74. [DOI: 10.1016/j.ijnurstu.2015.06.006] [Citation(s) in RCA: 250] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 06/12/2015] [Accepted: 06/16/2015] [Indexed: 11/20/2022]
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Lee MTG, Lin HY, Lee SH, Lee SH, Chang SS, Chen SC, Lee CC. Risk of skin ulcerations associated with oral nicorandil therapy: a population-based study. Br J Dermatol 2015; 173:498-509. [PMID: 25939634 DOI: 10.1111/bjd.13884] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although healthcare products regulatory agencies have issued warnings on risk of ulceration associated with the use of nicorandil, a population-based study has not been carried out. OBJECTIVES To determine the relationship between use of nicorandil and skin ulceration. METHODS We carried out a population-based study using a cohort of 1 million people assembled from Taiwan's national health insurance database. The association between nicorandil use and skin ulcers was estimated by a Cox proportional hazards regression model adjusting for a nicorandil-specific propensity score (PS) comprising of 86 potential predictors (c-statistic = 0·91). RESULTS The prospective cohort was longitudinally followed from January 2005 to December 2009, during which 1268 new users of nicorandil and 771 136 nonusers were identified. A higher frequency of skin ulcers (29 of 1268; 2·3%) was observed for users of nicorandil compared with nonusers (3231 of 771 136; 0·4%). Compared with nonusers, the crude hazard ratio (HR) associating nicorandil use with skin ulcers was 5·52 [95% confidence interval (CI) 3·82-7·95] and the PS-adjusted HR was 1·85 (95% CI 1·27-2·69). A risk period analysis showed that the risk of skin ulceration among users of nicorandil was greatest in the first year. Subgroup analysis found that the interaction term reached statistical significance (P < 0·05) for age and diabetes. CONCLUSIONS Use of nicorandil was found to be associated with an increased risk for skin ulceration, especially in the first year after incident exposure. We suggest that regulatory agencies re-evaluate the risk for skin ulceration associated with use of nicorandil.
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Affiliation(s)
- M-T G Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - H-Y Lin
- Department of Dermatology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.,Hsin-Yi Lin Dermatological Clinic, Taipei, Taiwan
| | - S-H Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming University Hospital, Taipei, Taiwan
| | - S-S Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.,College of Medicine, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, 333, Taiwan
| | - S-C Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - C-C Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, 640, Taiwan.,Department of General Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, 640, Taiwan
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White-Chu EF, Conner-Kerr TA. Overview of guidelines for the prevention and treatment of venous leg ulcers: a US perspective. J Multidiscip Healthc 2014; 7:111-7. [PMID: 24596466 PMCID: PMC3930479 DOI: 10.2147/jmdh.s38616] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Comprehensive care of chronic venous insufficiency and associated ulcers requires a multipronged and interprofessional approach to care. A comprehensive treatment approach includes exercise, nutritional assessment, compression therapy, vascular reconstruction, and advanced treatment modalities. National guidelines, meta-analyses, and original research studies provide evidence for the inclusion of these approaches in the patient plan of care. The purpose of this paper is to review present guidelines for prevention and treatment of venous leg ulcers as followed in the US. The paper further explores evidence-based yet pragmatic tools for the interprofessional team to use in the management of this complex disorder.
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Affiliation(s)
- E Foy White-Chu
- Oregon Health and Science University, Portland VA Medical Center, Portland, OR
| | - Teresa A Conner-Kerr
- Winston-Salem State University, Department of Physical Therapy, Winston Salem, NC, USA
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Butcher G, Pinnuck L. Wound bed preparation: ultrasonic-assisted debridement. ACTA ACUST UNITED AC 2013; 22:S36, S38-43. [DOI: 10.12968/bjon.2013.22.sup4.s36] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L, Garcia J. Autologous platelet-rich plasma for treating chronic wounds. Cochrane Database Syst Rev 2012; 10:CD006899. [PMID: 23076929 DOI: 10.1002/14651858.cd006899.pub2] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Autologous platelet-rich plasma (PRP) is a treatment that contains fibrin and high concentrations of growth factors and has the potential to aid wound healing. OBJECTIVES To determine whether autologous PRP promotes the healing of chronic wounds. SEARCH METHODS We searched the Cochrane Wounds Group Specialised Register (searched 15 August 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 8); Ovid MEDLINE (1950 to August Week 1 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, August 14, 2012); Ovid EMBASE (1980 to 2012 Week 32); EBSCO CINAHL (1982 to 10 August 2012) and International Clinical Trials Registry Platform (ICTRP)(accessed 22 August 2012). No date or language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared autologous PRP with placebo or alternative treatments for any type of chronic wound in adults. DATA COLLECTION AND ANALYSIS Two review authors independently assessed each study against the inclusion criteria, extracted data and assessed risk of bias for all included trials. We calculated the risk ratio (RR) or the mean difference (MD) and time to wound healing was analysed as survival data using the hazard ratio (HR). We considered heterogeneity as significant when I(2) was >75%. MAIN RESULTS Nine eligible RCTs were included, with a total of 325 participants of whom 44% were women. The median number of participants per RCT was 26 (range 10 to 86). Four RCTs recruited people with mixed chronic wounds (there were participants with wounds caused by more than one aetiology and participants who had wounds of several aetiologies in the same trial), three RCTs recruited people with venous leg ulcers and two RCTs considered foot ulcers in people with diabetes. The median length of treatment was 12 weeks (range eight to 40 weeks).One study was at low risk of bias, three studies were at high risk of bias with the remainder being at overall unclear risk of bias. The proportion of completely healed chronic wounds was reported in seven RCTs that compared PRP with standard treatment or placebo, with no statistically significant difference between the groups, in diabetic foot ulcers (RR 1.16; 95% CI 0.57 to 2.35), in venous leg ulcers (pooled RR 1.02; 95% CI 0.81 to 1.27; I(2)=0% ) and in mixed chronic wounds (pooled RR 1.85; 95% CI 0.76 to 4.51; I(2)=42%). The total area epithelialised at the end of the intervention was reported in three RCTs of mixed chronic wounds, there was no statistically significant difference between the groups (pooled MD -1.94 cm(2); 95% CI -4.74 to 0.86; I(2)=47%). The percentage of wound area healed was reported in two RCTs of mixed chronic wounds, and results were statistically significant in favour of the PRP group (RR 51.78%; 95% CI 32.70 to 70.86; I(2)= 0%). Wound complications like infection or necrosis were reported by three RCTs, and there was no statistically significant difference between groups (RR 1.08; 95% CI 0.31 to 3.73). Adverse effects were reported by three studies and there was no statistically significant difference between people treated with PRP and those not given PRP (pooled RR 1.07; 95% CI 0.32 to 3.58; I(2)=0%). AUTHORS' CONCLUSIONS There is currently no evidence to suggest that autologous PRP is of value for treating chronic wounds. However, current evidence is based on a small number of RCTs, most of which are either at high or unclear risk of bias. Well-designed and adequately powered clinical trials are needed.
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Affiliation(s)
- Maria José Martinez-Zapata
- Iberoamerican Cochrane Centre. Universitat Autònoma de Barcelona. Institute of Biomedical Research Sant Pau (IIB Sant Pau),Barcelona, CIBER Epidemiología y Salud Pública (CIBERESP), Spain, Barcelona, Spain.
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Yan S, Colin X, Coudray-Omnès C, Guido-Morin P, Kommala DR. A budget impact analysis comparing a Hydrofiber® ; dressing to an alginate dressing in managing exuding venous leg ulcers in France. Int Wound J 2012; 11:304-13. [PMID: 23020759 DOI: 10.1111/j.1742-481x.2012.01095.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
An Excel model was developed to compare total costs (including primary and secondary dressings only) of Hydrofiber(®) ; dressing (2010 branded price) versus an alginate dressing (generic or branded price) in managing exuding venous leg ulcers considering mean wear time and mean duration of exudate management phase, from the French Social Security perspective over 5 years (2011-2015). Budget impact (based on prevalence of venous leg ulcers in France) was estimated as the difference between scenario 1 (Hydrofiber(®) ; versus alginate dressing usage proportion increasing slightly per year) and Scenario2 (proportion remaining at 2010 levels). Annual costs and net savings per patient for the dressings were calculated in analyses 1 and 2. Analysis 1 (28-day mean exudate management phase for both Hydrofiber(®) ; and alginate dressing groups): total costs 66·82€ Hydrofiber(®) ;, 70·08€ generic alginate, 77·0€ branded alginate; net savings 3·26€ and 10·18€ for Hydrofiber(®) ; versus generic and branded alginate. Analysis 2 (mean exudate management phase of 22·2 versus 28 days for Hydrofiber(®) ; versus alginate): total costs 52·92€, 70·08€ and 77·0€, and net savings 17·10€ and 24·02€, accordingly. Total cost savings (budget impact scenario 1 minus scenario 2): Analysis 1 - 223 107€ and 696 304€ for Hydrofiber(®) ; versus generic and branded alginate dressings, respectively; Analysis 2 - 1 169 845€ and 1 643 042€ accordingly. Sensitivity analyses indicated that results are reliable. This conservative analysis shows that effective exudate management using Hydrofiber(®) ; dressing can produce sizeable cost savings.
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Affiliation(s)
- Songkai Yan
- Health Economics Strategy & Communications, ConvaTec, Inc., Skillman, NJ, USACemka-Eval, Bourg-la-Reine, FranceLaboratoires ConvaTec, La Garenne-Colombes, FranceConvaTec, Inc., Skillman, NJ, USA
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Brem H, Maggi J, Nierman D, Rolnitzky L, Bell D, Rennert R, Golinko M, Yan A, Lyder C, Vladeck B. High cost of stage IV pressure ulcers. Am J Surg 2010; 200:473-7. [PMID: 20887840 PMCID: PMC2950802 DOI: 10.1016/j.amjsurg.2009.12.021] [Citation(s) in RCA: 216] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 12/09/2009] [Accepted: 12/09/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to calculate and analyze the cost of treatment for stage IV pressure ulcers. METHODS A retrospective chart analysis of patients with stage IV pressure ulcers was conducted. Hospital records and treatment outcomes of these patients were followed up for a maximum of 29 months and analyzed. Costs directly related to the treatment of pressure ulcers and their associated complications were calculated. RESULTS Nineteen patients with stage IV pressure ulcers (11 hospital-acquired and 8 community-acquired) were identified and their charts were reviewed. The average hospital treatment cost associated with stage IV pressure ulcers and related complications was $129,248 for hospital-acquired ulcers during 1 admission, and $124,327 for community-acquired ulcers over an average of 4 admissions. CONCLUSIONS The costs incurred from stage IV pressure ulcers are much greater than previously estimated. Halting the progression of early stage pressure ulcers has the potential to eradicate enormous pain and suffering, save thousands of lives, and reduce health care expenditures by millions of dollars.
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Affiliation(s)
- Harold Brem
- Division of Wound Healing and Regenerative Medicine, Helen and Martin Kimmel Wound Center, Department of Surgery, New York University School of Medicine, New York, NY, USA.
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Baumgarten M, Margolis D, Orwig D, Hawkes W, Rich S, Langenberg P, Shardell M, Palmer MH, McArdle P, Sterling R, Jones PS, Magaziner J. Use of pressure-redistributing support surfaces among elderly hip fracture patients across the continuum of care: adherence to pressure ulcer prevention guidelines. THE GERONTOLOGIST 2009; 50:253-62. [PMID: 19587108 DOI: 10.1093/geront/gnp101] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To estimate the frequency of use of pressure-redistributing support surfaces (PRSS) among hip fracture patients and to determine whether higher pressure ulcer risk is associated with greater PRSS use. DESIGN AND METHODS Patients (n = 658) aged >or=65 years who had surgery for hip fracture were examined by research nurses at baseline and on alternating days for 21 days. Information on PRSS use and pressure ulcer risk factors was recorded at each assessment visit. Other information was obtained by interview and chart review. RESULTS A PRSS was observed at 36.4% of the 5,940 study visits. The odds of PRSS use were lower in the rehabilitation setting (adjusted odds ratio [OR] 0.4, 95% confidence interval [CI] 0.3-0.6), in the nursing home (adjusted OR 0.2, 95% CI 0.1-0.3), and during readmission to the acute setting (adjusted OR 0.6, 95% CI 0.4-0.9) than in the initial acute setting. There was wide variation in frequency of PRSS use by admission hospital, even after adjusting for pressure ulcer risk factors. The relationships between PRSS use and pressure ulcer risk factors were not strong. IMPLICATIONS In this study of hip fracture patients, adherence to guidelines for PRSS use was low and was based more on facility-related factors than on patient risk. There is an urgent need for health care providers to improve strategies for the prevention of pressure ulcers in high-risk patients.
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Affiliation(s)
- Mona Baumgarten
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 West Redwood Street, Suite 200, Baltimore, MD 21201, USA.
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Baumgarten M, Margolis DJ, Orwig DL, Shardell MD, Hawkes WG, Langenberg P, Palmer MH, Jones PS, McArdle PF, Sterling R, Kinosian BP, Rich SE, Sowinski J, Magaziner J. Pressure ulcers in elderly patients with hip fracture across the continuum of care. J Am Geriatr Soc 2009; 57:863-70. [PMID: 19484841 PMCID: PMC3382012 DOI: 10.1111/j.1532-5415.2009.02245.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify care settings associated with greater pressure ulcer risk in elderly patients with hip fracture in the postfracture period. DESIGN Prospective cohort study. SETTING Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged. PARTICIPANTS Hip fracture patients aged 65 and older who underwent surgery for hip fracture. MEASUREMENTS A full-body skin examination was conducted at baseline (as soon as possible after hospital admission) and repeated on alternating days for 21 days. Patients were deemed to have an acquired pressure ulcer (APU) if they developed one or more new stage 2 or higher pressure ulcers after hospital admission. RESULTS In 658 study participants, the APU cumulative incidence at 32 days after initial hospital admission was 36.1% (standard error 2.5%). The adjusted APU incidence rate was highest during the initial acute hospital stay (relative risk (RR)=2.2, 95% confidence interval (CI)=1.3-3.7) and during re-admission to the acute hospital (RR=2.2, 95% CI=1.1-4.2). The relative risks in rehabilitation and nursing home settings were 1.4 (95% CI=0.8-2.3) and 1.3 (95% CI=0.8-2.1), respectively. CONCLUSION Approximately one-third of hip fracture patients developed an APU during the study period. The rate was highest in the acute setting, a finding that is significant in light of Medicare's policy of not reimbursing hospitals for the treatment of hospital-APUs. Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals.
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Affiliation(s)
- Mona Baumgarten
- University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore MD
| | - David J. Margolis
- University of Pennsylvania School of Medicine, Departments of Biostatistics & Epidemiology, and Dermatology, Philadelphia PA
| | - Denise L. Orwig
- University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore MD
| | - Michelle D. Shardell
- University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore MD
| | - William G. Hawkes
- University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore MD
| | - Patricia Langenberg
- University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore MD
| | - Mary H. Palmer
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill NC
| | - Patricia S. Jones
- University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore MD
| | - Patrick F. McArdle
- University of Maryland School of Medicine, Departments of Medicine, and Epidemiology & Preventive Medicine, Baltimore MD
| | - Robert Sterling
- University of Maryland School of Medicine, Department of Orthopaedics, Baltimore MD
| | - Bruce P. Kinosian
- University of Pennsylvania School of Medicine, Department of Medicine, Philadelphia PA
| | - Shayna E. Rich
- University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore MD
| | | | - Jay Magaziner
- University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore MD
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Baumgarten M, Shardell M, Rich S. Methodological issues in studies of the effectiveness of pressure ulcer prevention interventions. Adv Skin Wound Care 2009; 22:180-8; quiz 189-90. [PMID: 19325278 PMCID: PMC2841287 DOI: 10.1097/01.asw.0000305462.32800.7b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To enhance the wound care practitioner's understanding of the research methods used to obtain information about the effectiveness of pressure ulcer prevention interventions. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After reading this article and taking this test, the reader should be able to: 1. Differentiate between randomized, historical, and nonrandomized comparison studies. 2. Explain terminology and concepts associated with pressure ulcer prevention research.
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Affiliation(s)
- Mona Baumgarten
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Abstract
PURPOSE OF REVIEW Cachexia is a progressive deterioration of body habitus associated with certain chronic diseases (e.g., cancer, chronic obstructive pulmonary disease, chronic heart failure, and chronic kidney disease). The aim of this article is to describe the prevalence and impact of cachexia (and precachexia) in such patients. RECENT FINDINGS Owing to the wide spectrum of clinical presentation and lack of an 'all-inclusive' definition, it is difficult to estimate the true prevalence of cachexia. Perhaps 2% of the population suffer from precachexia (characterized by weight loss in association with a chronic disease). The significant increase in obesity of the general population (which can mask significant muscle wasting) confounds such simple estimates of the true prevalence of cachexia. In contrast, a multidimensional characterization of the cachectic state (including weight loss, reduced food intake, and systemic inflammation) may be more meaningful in terms of altered clinical outcomes. Such a multidimensional view of cachexia has been shown to impact on patients' survival and quality of life and therefore constitutes a major public health issue. SUMMARY There is a high prevalence of (pre)cachexia in patients with chronic diseases. The cachexia syndrome is probably less frequent but has a significant impact in terms of morbidity and mortality.
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Affiliation(s)
- Benjamin H L Tan
- Clinical and Surgical Sciences (Surgery), University of Edinburgh, Royal Infirmary, Edinburgh, UK
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Catania K, Huang C, James P, Madison M, Moran M, Ohr M. PUPPI: The Pressure Ulcer Prevention Protocol Interventions. Am J Nurs 2007. [DOI: 10.1097/00000446-200704000-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
AIM To examine critically the literature published in the Turkish language (1955-2004) related to risk assessment tool(s), their application to nursing care and prevention of pressure ulcers (PrUs). Specific objectives were to identify the advantages of risk assessment and prevention of PrUs in hospital; to establish the most valid and reliable methods available to evaluate the effectiveness of PrU prevention programmes; to determine methodological problems encountered by researchers and explore how these were overcome; and to present the findings so they could be used to develop a valid and reliable audit tool based upon the empirical evidence. METHODS All journals and convention booklets published in Turkey related to nursing between the years 1955-2004 were examined. Because many journals in Turkey are not yet available by electronic means, the published Turkish articles were all examined by hand. A total of 3031 articles in 17 nursing journals and 36 congress books (convention booklets) were examined. Five articles were found to meet the study criteria and were taken into the study and evaluated. CONCLUSION There is a need to determine valid and reliable assessment methods, and the results need to be recorded on standard forms. In addition, it is important to increase the motivation of nursing personnel who give direct patient care to use the tools available in order to prevent the development of PrUs. From the review findings it is apparent that in Turkey, there is a dearth of research evidence upon which to base practice in the sphere of PrU prevention, and further research is urgently required.
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Affiliation(s)
- A D Akyol
- Egean University High School of Nursing, Izmir, Turkey.
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Abstract
AbstractWhen conducting prevalence surveys pressure ulcers were found in participants clearly identified not to be at risk. This article determines and analyses persons in German hospitals and nursing homes who suffer from pressure ulcers but are not at risk. In the years 2002, 2003 and 2004 there were 7,097 nursing home residents and 23,966 hospital patients examined in annual pressure ulcer prevalence surveys. A risk assessment according to the Braden Scale was performed for each participant on the day of the survey. “Not at risk” participants were defined by Braden score cut-off > 20 points. There were 440 of 3,012 (14.6%) persons with pressure ulcer who were considered not to be at risk. In hospitals, 16.1% of all patients with pressure ulcers were not at risk, in nursing homes it was 8.2%. A high variance between medical specialties and individual institutions was found in the number of those not at risk but with pressure ulcer. In the group not at risk, persons with and without a pressure ulcer differed regarding activity and friction and shear in nursing homes. In hospitals those persons differed regarding age and all single items of the Braden scale apart from sensory perception. Pressure ulcers that are more severe, located at the hip or lower back or the origin of which is unknown are more likely to be considered to be at risk by the Braden risk assessment tool.The results may indicate insufficient abilities of the Braden scale for certain kind of pressure ulcer wounds.
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Courtney BA, Ruppman JB, Cooper HM. Save our skin: Initiative cuts pressure ulcer incidence in half. ACTA ACUST UNITED AC 2006; 37:36, 38, 40 passim. [PMID: 16603946 DOI: 10.1097/00006247-200604000-00010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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