Summary of findings 4. Foam dressings compared with basic contact dressings for treating pressure ulcers.
| Foam dressings compared with basic contact dressings for treating pressure ulcers | |||||||
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Patient or population: people of any age with an existing pressure ulcer Category/Stage II or above Settings: any care setting Intervention: polyurethane, silver and ibuprofen‐releasing foam dressings Comparison: basic contact dressings (gauze, saline‐soaked gauze, low‐adherence dressing secured by a vapour‐permeable film) | |||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Subgroup differences | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with basic contact dressings | Risk with foam dressing | ||||||
| Incidence of healing, short‐term follow‐up (8 weeks of less) | 375 per 1000 | 500 per 1000 (233 to 1080) | RR 1.33 (0.62 to 2.88) | Chi2 = 0.09, df = 1, (P = 0.77), I2 = 0.0% | 36 (1 RCT) | ⊕⊝⊝⊝ very low1 | |
| Incidence of healing, medium‐term follow‐up (8 to 24 weeks) | 625 per 1000 | 731 per 1000 (494 to 1075) | RR 1.17 (0.79 to 1.72) | 50 (1 RCT) | ⊕⊝⊝⊝ very low2 | ||
| Time to complete healing (days) medium‐term follow‐up (8 to 24 weeks) | The mean time to complete healing (days) was 121.4 days | The mean time to complete healing with foam dressing was 35.80 days less (56.77 to 14.83 less) | 95 (1 RCT) | ⊕⊝⊝⊝ very low3 |
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| Adverse events, medium‐term follow‐up (8 to 24 weeks) | 438 per 1000 | 254 per 1000 (145 to 460) | RR 0.58 (0.33 to 1.05) | 95 (1 RCT) | ⊕⊕⊝⊝ low4 | ||
| Quality of life | Outcome not measured or reported for this comparison | Outcome not measured or reported for this comparison | n/a | n/a | Outcome not measured or reported for this comparison | ||
| Incremental cost per event, short‐term follow‐up (8 weeks or less) | Per patient cost USD 781 | Per patient cost USD 315 | n/a | 36 (1 RCT) | ⊕⊝⊝⊝ very low5 | Cost difference between intervention and comparator dressings = USD 466. Treatment cost data for intervention and comparator dressings, other materials and nurse time based on national standard costs in the USA in mid‐2007 and hourly wages for nurses based on 2006 rates |
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| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio | |||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | |||||||
1Majority of evidence at high risk of bias due to limitations in design and implementation due to lack of blinding (downgraded once); very serious imprecision of results due to small sample size, wide confidence intervals and incomplete reporting (0.62 to 2.88) (downgraded twice) 2Majority of evidence at high risk of bias due to limitations in design and implementation due to lack of blinding (downgraded once); very serious imprecision of results due to small sample size, wide confidence intervals and incomplete reporting (0.79 to 1.72) (downgraded twice) 3Majority of evidence at high risk of bias due to limitations in design and implementation due to lack of blinding (downgraded twice); very serious imprecision of results due to small sample size, wide confidence intervals and incomplete reporting (‐56.77 to ‐14.835) (downgraded once). 4Majority of evidence at high risk of bias due to limitations in design and implementation due to lack of blinding (downgraded once); very serious imprecision of results due to small sample size, wide confidence levels and incomplete reporting (0.33 to 1.05) (downgraded once).