versión impresa ISSN 1134-928X
GARCIA FERNANDEZ, Francisco Pedro et al. Efficiency of the products for pressure ulcers treatment: a systematic review with meta-analysis. Gerokomos [online]. 2007, vol.18, n.1, pp.36-48. ISSN 1134-928X.
Aims: To evaluate the clinical efficiency of the available products for pressure ulcers (PU) treatment which are based on moist environment treatment (MET) and their cost-effectiveness. Sources of data: The search of published studies was carried out in bibliographical databases: CINAHL, Cuiden Plus, Embase, LILACS and MEDLINE. An inverse search was also carried out, with secondary recovery. Unpublished studies were not included. Methods of review: Clinical trials comparing: a) products based on MET and traditional treatments (TT) and b) different types of products of MET, for PU treatments. Every article was assessed independently by two reviewers, using CASP and the GRADE system for assessing the quality of evidence. Data extracted were general data, data on clinical efficiency, data of cost-effectiveness and data about dressing performance. To estimate the effect we used the relative risk (RR) with a 95% confidence interval. A meta-analysis (random effects model) was carried out when appropriate. Results: 66 potentially relevant studies were identified. 30 were excluded because of scoring CASP< 5 and 10 were not considered for analysis because of a very low quality of evidence. A meta-analysis shows the advantage of the use of hydrocolloid (HCL) vs. TT (RR= 2.05 IC 95% 1.20-3.52). Individual studies that do not permit metaanalysis show the advantage of other products of MET vs. TT and a metaanalysis of all studies comparing MET vs. TT confirms it (RR= 1.61 IC 95% 1.28-2.02). There are no differences in clinical efficiency of HCL vs. polyurethane foam (PF) (RR= 1.11 IC 95% 0.60-2.05), nor between other products. Different studies show that products based on MET (HCL and PF) are more cost-effective than the TT. Foams show greater exudates absorption capacity and are removed easier than HCL. Conclusions: They are many studies with a very low quality of evidence or with too small a sample, which does not permit to consider them. Products based on MET for PU treatment have greater clinical efficiency and are more cost-effective than TT. There is no difference in the clinical efficiency between different types of MET products. Foams advantage HCL in comfort and exudates absorption.
Palabras clave : Meta-analysis; systematic review; pressure ulcer; dressings; cost-efficiency; moist environment treatment.