Wednesday, August 23, 2006
Treating pressure ulcers in just one patient can cost up to $70,000.
SCRIPPS HOWARD
American medicine spends an estimated $11 billion a year to treat roughly 2.5 million pressure sores in hospitals alone, yet a new study finds there's little scientific evidence about what works best to prevent or treat these injuries of immobility.
Researchers at Women's College Hospital and Baycrest Geriatric Health Care System in Toronto did a review of what's known about preventing the injuries, commonly called bedsores. The findings were published today in The Journal of the American Medical Association.
"Pressure ulcers are common in a variety of settings and are associated with adverse health outcomes and high treatment costs," said Dr. Madhuri Reddy, a geriatrician and chronic-wound specialist at Women's College and lead author of the report.
"We found that the majority of the 59 randomized trials that have examined interventions to prevent pressure ulcers have been inadequate in their design and have not generated robust scientific evidence from which to develop comprehensive best-practice guidelines," added Reddy, who recently moved to Hebrew Rehabilitation Center in Boston.
The late actor-activist Christopher Reeve often mentioned his struggles with pressure ulcers after he became paralyzed in a 1995 horseback-riding accident. His death in 2004 was caused by heart failure, but by some accounts an infected pressure sore may have contributed.
Who gets them
Although bedsores have typically been associated with the elderly and younger people immobilized by injury or illness for a long time, 60 percent of pressure ulcers develop in patients admitted to acute-care hospitals.
An immobile person can develop pressure ulcers within three to six hours of lying on an emergency-room stretcher. Ulcers can range from slight skin discolorations to open sores that go all the way to the bone. They frequently develop around the tailbone, hips and heels.
The 59 studies, conducted over the past 30 years, represent a surprisingly meager research effort given the expense and risk of the wounds, which can cost between $500 and $70,000 to treat in even one patient, the researchers argue. Other researchers have estimated the cost of treating bedsores in acute-care settings in the United States at $11 billion annually. Studies in Canada have suggested that as many as one in four patients across all inpatient health-care settings suffers from pressure ulcers.
Battling the ulcers
Prevention methods studied over the years include regularly repositioning patients in beds and wheelchairs, and using specialized mattresses, nutritional supplements and skin lotions. But the studies, mostly done in hospitals, shed little light on what works best or even how interventions should be used in different settings and patient groups.
"There seems to be a huge mismatch between the billions of dollars we're spending on treating this condition, including an incredible amount of nursing time, and the relatively little effort in determining the best practices for prevention," said Dr. Paula Rochon, a geriatrician and scientist at Baycrest and senior author of the study.
The researchers evaluated the quality of the studies using a standardized checklist for clinical research, and found that only three of the 59 met all the criteria.
While repositioning is considered to be a crucial strategy, the studies don't tell doctors and nurses precisely how often a patient should be turned or what the best method is to use. There's even less certainty about other approaches.
"The bottom line is that we still don't know what the most cost-effective strategies are for preventing pressure ulcers in high-risk populations," Reddy said.