评估所有已发表的研究,这些研究描述了由于检测到表皮下水分(SEM)增量(Δ≥0.6)而导致的压疮/损伤(PI/PU)护理途径的交付发生了什么。我们对文献进行了系统的回顾,并包括使用前瞻性或回顾性研究设计的原始研究研究,报告使用SEM评估的评估对有发展PI/PU风险的成人的PI/PU护理途径的提供的影响。审查方案在PROSPERO(CRD42023416975)上注册。2023年5月,使用PubMed进行了文献检索,CINAHL,Scopus,科克伦,EMBASE,WebofScience和ScienceDirect数据库。使用数据提取工具提取数据,包括国家、设置,样本量,干预,使用循证图书馆学进行控制和质量评估。我们确定了2017年至2022年之间发表的9篇论文。这些研究中的大多数在英格兰进行(n=6;67%)。系统评价包括在包括急性护理在内的多种护理环境中进行的研究,医疗外科单位,和姑息治疗,强调PI/PU在不同患者人群中预防和管理的重要性。研究中实施的PI/PU护理途径各不相同,但通常包括的元素,如应用或增加使用压力重新分配床垫/垫子,重新定位计划的实施,失禁和水分的管理,定期皮肤检查,和评估患者的流动性。在确定的九项研究中,7例报告PI/PU发生率。对7项研究(N=18451)的荟萃分析显示,与常规护理相比,SEM指导的护理途径在视觉PI/PU发展方面有统计学意义的显着降低(比值比=0.36[95%置信区间:0.24-0.53,p<0.00001])。本系统综述提供了证据,表明在有发展PI/PU风险的患者中实施SEM评估会提示解剖学特定的临床行动。随后实施增强的和有针对性的皮肤护理干预措施导致医院获得性PU发病率的一致和持续降低。研究结果强调了在所有护理环境和患者人群中纳入SEM评估作为全面PI/PU预防策略的一部分的重要性。这种系统评价受到观察性研究的优势和可变研究质量的限制。未来的研究应集中在不同护理环境中的随机试验,监测预防性干预措施的有效性及其在基于SEM评估实施时降低PI/PU发生率的影响。
To assess all published studies which describe what happens to the delivery of pressure ulcer/injury (PI/PU) care pathways as a result of detecting raised sub-epidermal moisture (SEM) delta (∆ ≥ 0.6). We undertook a systematic
review of the literature, and included original research studies using either a prospective or retrospective study design that report the impact that assessment using SEM assessments have on healthcare practitioners\' delivery of PI/PU care pathways in adults at risk of developing PI/PUs. The
review protocol was registered on PROSPERO (CRD42023416975). A literature search was conducted in May 2023, using PubMed, CINAHL, Scopus, Cochrane, EMBASE, Web of Science and Science Direct databases. Data were extracted using a data extraction tool including elements such as country, setting, sample size, intervention, control and quality appraisal was undertaken using the Evidence-based Librarianship. We identified nine papers published between 2017 and 2022. The majority of these studies were conducted in England (n = 6; 67%). The systematic
review included studies conducted across multiple care settings including acute care, medical-surgical units, and palliative care, highlighting the importance of PI/PU prevention and management across diverse patient populations. The PI/PU care pathways implemented in the studies varied, but commonly included elements such as the application or increased use of pressure-redistributing mattresses/cushions, implementation of repositioning plans, management of incontinence and moisture, regular skin inspection, and assessment of patient mobility. Out of the nine studies identified, seven reported PI/PU incidence. A meta-analysis of seven studies (N = 18 451) demonstrated a statistically significant reduction in visual PI/PU development in favour of SEM-guided care pathways compared to usual care (the odds ratio = 0.36 [95% confidence interval: 0.24-0.53, p < 0.00001]). This systematic
review provides evidence that implementing SEM assessments in patients at risk of developing PI/PUs prompts anatomy-specific clinical actions. The subsequent implementation of enhanced and targeted skin care interventions leads to consistent and sustained reductions in hospital-acquired PU incidence. The findings emphasise the importance of incorporating SEM assessments as part of comprehensive PI/PU prevention strategies in all care settings and patient populations. This systematic
review is limited by the predominance of observational studies and variable study quality. Future research should focus on randomised trials in different care settings that monitor the efficacy of preventive interventions and their impact in reducing PI/PU incidence when implemented based on SEM assessments.