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SCI: Pressure Ulcers (2007)

Citation:

Consortium for Spinal Cord Medicine Clinical Practice Guidelines. Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals. J Spinal Cord Med 2001;24 Suppl 1:S40 - S101.

 
Study Design:
Evidence-based Clinical Practice Guideline
Class:
M - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:
  • To provide guidance and assistance in the decisions required to restore health, independence, control, and self-esteem to people with spinal cord injury. Document provides the conceptual framework within which to develop effective strategies for preventing and treating pressure ulcers.
Inclusion Criteria:
  • English
  • Across the continuum from point of injury to integration into home/community
  • Study designs of clinical trials (randomized and nonrandomized), cohort studies, case control, case series, and cross-over studies.
Exclusion Criteria:
  • Animal studies, children under age 13, non-traumatic paralysis, case reports and n of one.
Description of Study Protocol:

Recruitment:  Preliminary search of MEDLINE from 1966 - 1998 was conducted.  Appropriate key words and Index Medicus subheadings were used to search the MEDLINE database and CINAHL database.

Design:  Evidence-based Clinical Practice Guideline

Blinding Used (if applicable):  not applicable

Intervention (if applicable):

  • Twelve step guideline development process including “consultant methodologists review the international literature, prepare evidence tables that grade and rank the quality of research, and conduct statistical meta-analyses and other specialized studies, as needed.” Expert panel members write in their area of expertise using the references and other materials furnished by the methodology support group. Iterative process employed to incorporate new literature citations or other evidence-based information not previously available.
  • Three steps to the grading process: Each evidence source graded by type of study—Level I (large randomized trials with clear-cut results (and low risk of error)) to Level V (case series with no controls). Recommendation graded by number and type of studies. Grading of panel consensus—low, moderate, or strong.

Statistical Analysis

Statistical analysis not completed.

Data Collection Summary:

Timing of Measurements:  not applicable

Dependent Variables

  • Pressure Ulcers

Independent Variables

  • Spinal Cord Injury

Control Variables

Description of Actual Data Sample:

Initial N:  Over 400 references

Attrition (final N):  as above

Age:  not mentioned

Ethnicity:  not mentioned

Other relevant demographics:

Anthropometrics:

Location:  Worldwide studies

Summary of Results:

Recommendations

32 recommendations, including Nutrition and Complications of Pressure Ulcers.

Assess nutritional status of all SCI individuals on admission and as needed, based on medical status including: dietary intake (inadequate intake, 3 days worsening appetite), anthropometric measurements (most reference standards are not applicable in SCI), and:

  • Biochemical parameters
  • Prealbumin: 19-43 mg/dL
  • Total protein: 6.0-8.0 g/dL
  • Albumin: 3.5-5.0 g/dL
  • Hemoglobin female: 11.5-15.5
  • Male: 14.0-18.0 g/dL
  • Hematocrit female: 33-44%
  • Male: 39-49%
  • Transferrin: 200-400 mg/dL
  • Total lymphocyte count: 1500-4000/mm3.

(Scientific evidence—II/III/V; Grade of recommendation—B/C; Strength of panel opinion—Strong)

Provide adequate nutritional intake to meet individual needs, especially for: calories, protein, micronutrients (zinc, vitamin c, vitamin A, and vitamin E), fluids.

(Scientific evidence—II/III/V; Grade of recommendation—B/C; Strength of panel opinion—Strong)

Implement aggressive nutritional support measures if dietary intake is inadequate or if an individual is nutritionally compromised.

(Scientific evidence—II; Grade of recommendation—B; Strength of panel opinion—Strong)

Author Conclusion:

See Recommendations in Results.

 

Funding Source:
Not-for-profit
0
Foundation associated with industry:
Reviewer Comments:
  • Recommendations based on thorough review and integration of available evidence. Strengths and weakness of individual studies are not reported. Document is a rich source of information.
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  1. Will the answer if true, have a direct bearing on the health of patients? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? Yes
  4. Will the information, if true, require a change in practice? Yes
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? Yes
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? Yes
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? Yes
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes
  10. Was bias due to the review's funding or sponsorship unlikely? Yes