Wound cleansing for pressure ulcers

Prevention and treatment of pressure injuries: A meta-synthesis of Cochrane Reviews

“…1) shows the number of studies identified, screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage [21]. There were 27 reviews included in the qualitative syntheses; nine for PI prevention [27][28][29][30][31][32][33][34][35], and 21 for PI treatment [28,31,34,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]. Three reviews [28,31,34], examined both PI prevention and treatment.…”

“…Table 2 provides a summary of the PI treatment Cochrane Reviews. Twenty-one reviews published between 2006 and 2020 included 178 studies [28,31,34,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53], and 18,348 participants (range = 40 to 6963). Eleven reviews reported the GRADE assessments of the certainty of evidence for each outcome across included studies, judging them to be mostly low or very low quality [34,38,[40][41][42][43]45,49,[51][52][53].…”

“…Table 3 presents the methodological quality assessment of the reviews using the AMSTAR 2 tool. In total, 12 reviews [30,31,33-35, 38,40-42,45,47,53], were rated as high confidence, 11 reviews [27,32,37,39,43,44,[48][49][50][51][52], were rated as moderate confidence and three reviews [28,29,46], were rated as low confidence. A single review, published over 10 years ago was rated as critically low [36].…”

“…A single review, published over 10 years ago was rated as critically low [36]. For reviews that did not include any identified studies (n = 4) [31,33,47,48], or were not able to conduct a meta-analysis (n = 17) [30][31][32][33][34]37,[39][40][41][42][44][45][46][47][48][49][50], some AMSTAR 2 items could not be assessed and were not included in the summary score. Only 23 reviews were assessed on items 8-10 and 13-14, and only 10 reviews were examined for items 11-12 and 15.…”

“…We were unable to assess the publication bias (Item 15) for most of the reviews due to the absence of a quantitative synthesis, where for seven of ten reviews that could be assessed (70%) were found to adequately address this impact [27,35,38,43,[51][52][53]. The final identified weakness in the reviews were authors reporting a conflict of interests and funding (Item 16), with five reviews (19%) failing to address how these potential conflicts of interest were managed [32,46,48,49,52]. The Cochrane reviews also had common areas that were clear strengths with 96% including a list of excluded studies with justification (Item 7), 86% describing the studies in sufficient detail (Item 8), and 85% having an a priori design (Item 2).…”