Robust evidence exists for some wound care interventions, but there are still gaps in current knowledge requiring international consensus and further high-level clinical evidence, according to a paper published online by BJS , the British Journal of Surgery .
Researchers analysed the findings of 44 Cochrane Systematic Reviews (CSRs) published by the Cochrane Wounds and Peripheral Vascular Disease Groups up to June 2011. The reviews covered CSRs on acute wounds and chronic wounds such as venous, pressure, diabetic and arterial ulcers.
This enabled them to identify a number of findings that provide strong clinical evidence for treating specific wound issues.
"Acute and chronic wounds pose a substantial problem in different healthcare settings including emergency departments, nursing homes, home care and family doctor practices" says co-author Dr Dirk Ubbink, from the Academic Medical Centre in Amsterdam, The Netherlands.
"Because wounds have a considerable impact on patient health, death, daily functioning and quality of life, they deserve high-quality local and systemic treatment.
"Ideally wound treatment decisions should be based on the best available evidence, integrated with patients' concerns and priorities and fine-tuned by the local resources and skills. In reality, however, treatment decisions are generally based on the personal opinions, experiences and preferences of healthcare professionals, which can vary widely. This is partly due to the overwhelming amount of literature available, which often shows conflicting results.
"Our meta-review of the CSRs aims to help clinicians make evidence-based decisions by analysing studies of both local and systemic open wound care."
The meta-review covered 13 CSRs on venous ulcers, 12 on acute wounds, seven on pressure ulcers, six on diabetic ulcers, five on arterial ulcers and five on miscellaneous chronic wounds.
Findings were placed into five categories, based on strong evidence of effect/no effect, limited evidence of effect/no effect and no evidence either way.
Strong findings included:
Acute wounds
Chronic wounds
"Our meta-review drew 33 conclusions with strong evidence and 18 conclusions with fairly strong evidence from the CSRs we studied" says lead author Dr Fleur Brölmann. "Evidence was not available or insufficient in the remaining 58."
The paper has been published online early ahead of print publication in the September issue of BJS . It can be viewed free at: http://onlinelibrary.wiley.com/doi/10.1002/bjs.8810/full
A podcast discussion featuring the author and other clinicians can be found at http://www.yada-yada.co.uk/Blackwell/BJS/BJS_wound_dressing.mp3
Note to editors
Evidence-based decisions for local and systemic wound care. Brölmann et al. BJS . Published online early ahead of print publication in the September issue. (July 2012). DOI: 10.1002/bjs.8810
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Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care. Published in The Cochrane Library , they investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting.
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