Here - EWMA 2013

FREE PAPER SESSION: PRESSURE ULCERS AND HEALTH ECONOMICS
Free Paper Session: Pressure Ulcers and Health Economics
146
THE CORRELATION BETWEEN ULTRASOUND FINDINGS AND CLINICAL
ASSESSMENT OF PRESSURE RELATED ULCERS: IS THE EXTENT OF INJUY
GREATER THAN WHAT IS PREDICTED?
Kristen Aliano 1,2 , Christopher Low 1,2 , Steve Stavrides 1,2 , Johnathan Luchs 1,2 ,
Thomas Davenport 1,2
1 Long Island Plastic Surgical Group (Garden City, United States);
2 Winthrop University Hospital (Mineola, United States).
Aim: The current staging system by the U.S.’s National Pressure Ulcer Advisory Panel
(NPUAP) classifies the stages of pressure ulcers based on clinical assessment and
visual inspection. We postulate that patients presenting with clinically superficial stage I
wounds will have a greater depth of injury than predicted.
Methods: On admission, patients with sacral pressure ulcers were staged. Patients who
were classified as having a stage I or II pressure wounds or suspected deep tissue injury
were assessed with high-frequency (12-MHZ) ultrasonography (US) to identify any
evidence of injury to the deep tissue. Those patients classified as having stage III or IV
were excluded from the study.
Results: The study included 17 patients; 9 patients with Stage I pressure ulcers and 8
patients with suspected deep tissue injury. In all patients, the US demonstrated evidence
of injury to the deeper tissue layers. The abnormal sonographic signs indicating deep
tissue injury included loss of epidermal-dermal interface.
Conclusions: The current staging system has expanded to include suspected deep
tissue injury as an additional stage. In patients with suspected deep tissue injury, we
have found US to be a reliable diagnostic tool that confirms the clinical suspicion of deep
tissue injury. Interestingly, for the stage I pressure ulcers that appeared clinically
superficial, the US revealed evidence of associated deep tissue injury. This suggests
that pressure wounds classified as superficial may have a deeper tissue damage
component.
147
Free Paper Session: Pressure Ulcers and Health Economics
THE BORDER TRIAL: A PROSPECTIVE RANDOMISED CONTROLLED TRIAL OF
THE EFFECTIVENESS OF MULTI-LAYER SILICONE DRESSINGS IN PREVENTING
INTENSIVE CARE UNIT PRESSURE ULCERS
Nick Santamaria 1 , Marie Gerdtz 1 , Theresa Vassiliou 1 , Jonathan Knott 1 ,
Stepanie DeVincentis 2 , Sarah Sage 2 , Ai Wei Ng 2 , Jane McCann 2 , Amy Freeman 2 ,
Wei Liu 2
1 University of Melbourne & Royal Melbourne Hospital (Melbourne, Australia);
2 Royal Melbourne Hospital (Melbourne, Australia).
Pressure ulcers are a major source of morbidity in critically ill patients in the Intensive
Care Unit (ICU) and are often associated with tissue damage prior to the ICU admission.
Early identification and preventative management of patients at risk while in the
Emergency Department (ED) may reduce the pressure ulcer incidence rates in the ICU.
Aim: To determine the effectiveness of applying multi-layer silicone dressings* in the ED
in preventing sacral and heel pressure ulcer development in critically ill patients
transferred to ICU.
Methods: A randomised control trial was conducted with critically ill patients admitted to
the ED and subsequently transferred to the ICU. Eligible patients (n=440) were assigned
to either a control group receiving usual pressure prevention care or to an intervention
group receiving usual care and the application of multi-layer silicone dressings to their
sacrum and heels in the ED. The primary outcome measure was the pressure ulcer
incidence rate in ICU.
Results: When compared with the control group, there was significantly less patients
with a pressure ulcer (p=0.002), less total ulcers (p=0.003) and fewer sacral (p=0.03)
and heel pressure ulcers (p=0.005) in the intervention group.
Conclusions: The application of silicone dressings was effective in preventing sacral
and heel pressure ulcer development in critically ill patients.
* Mepilex ® Border Sacrum and Heel dressings
EWMA 2013
COPENHAGEN
15-17 May · 2013
Danish Wound
Healing Society
93