Oedema as a predictor of the incidence of new pressure injuries in adults in any care setting : A systematic review and meta-analysis

Journal article


Chaboyer, Wendy, Coyer, Fiona, Harbeck, Emma, Thalib, Lukman, Latimer, Sharon, Wan, Ching Shan, Tobiano, Georgia, Griffin, Bronwyn R., Campbell, Jill L., Walker, Rachel, Carlini, Joan J., Lockwood, Ishtar, Clark, Justin and Gillespie, Brigid M.. (2022). Oedema as a predictor of the incidence of new pressure injuries in adults in any care setting : A systematic review and meta-analysis. International Journal of Nursing Studies. 128, p. Article 104189. https://doi.org/10.1016/j.ijnurstu.2022.104189
AuthorsChaboyer, Wendy, Coyer, Fiona, Harbeck, Emma, Thalib, Lukman, Latimer, Sharon, Wan, Ching Shan, Tobiano, Georgia, Griffin, Bronwyn R., Campbell, Jill L., Walker, Rachel, Carlini, Joan J., Lockwood, Ishtar, Clark, Justin and Gillespie, Brigid M.
Abstract

Background
Oedema measurement, also termed sub-epidermal moisture measurement is recommended as an adjunct pressure injury prevention intervention in international guidelines because it indicates early tissue damage.

Objective
To determine the prognostic value of oedema measurement in predicting future pressure injury in adults in any care setting.

Design
Systematic review and meta-analysis.

Setting
Participants were recruited from nursing homes or aged care facilities, hospitals, or post-acute facilities.

Participants
Adults.

Methods
A modified 2-week systematic review was undertaken. Study designs included cohort (prospective and retrospective), case-control, case series if relevant comparisons were reported, randomised controlled trials if the association between oedema measurement and pressure injury was reported, and registry data. Databases searched included: Medical Literature Analysis and Retrieval System Online, The Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica and the Cochrane Library from inception to 13 July 2021 with no language restrictions. Screening, data extraction using Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies – Prognostic Factors (CHARMS-PF) and quality assessment using Quality in Prognostic Factor Studies (QUIPS) were undertaken independently by ≥2 authors and adjudicated by another if required. Meta-analyses and meta-regression were undertaken. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results
Six studies (n = 483 total) were included. Two studies were set in nursing homes and four in either hospitals or post-acute facilities. Fives studies were prospective cohorts, and one was a randomised control trial. Two studies were assessed as low risk and four studies as moderate risk of bias. The pooled risk ratio in four studies (n = 388) for the relationship between oedema and pressure injury cumulative incidence was 18.87 (95% CI 2.13–38.29) and for time to pressure injury was 4.08 days (95% CI 1.64–6.52). Using GRADE, the certainty of the body of evidence was low for all outcomes. Meta-regression indicated that age, gender, and sample size were poor predictors for the association between oedema and pressure injury.

Conclusions
Measuring oedema as a predictor for pressure injury development is showing promise but a stronger body of evidence that takes into consideration other prognostic factors is needed to better understand its benefit.

Registration
PROSPERO CRD42021267834.

Tweetable abstract: Measuring oedema is a promising strategy to prevent pressure injuries but the certainty of evidence for this claim is low.

Keywordsautomated review tools; point of care systems; pressure injury prevention; pressure ulcer; prognosis, systematic review
Year2022
JournalInternational Journal of Nursing Studies
Journal citation128, p. Article 104189
PublisherElsevier Ltd
ISSN0020-7489
Digital Object Identifier (DOI)https://doi.org/10.1016/j.ijnurstu.2022.104189
Scopus EID2-s2.0-85126089207
Page range1-12
FunderNational Health and Medical Research Council (NHMRC)
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online05 Feb 2022
Publication process dates
Accepted29 Jan 2022
Deposited12 Oct 2022
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