The quest for scientific evidence in pressure ulcers: five years, one goal, multiple ways
Arboledas Bellón J., Melero López A., Cobos Vargas A.

SUMMARY

Introduction and objectives: Pressure ulcers (PU) are the object of numerous scientific papers in our country. However…, do we really know the scientific quality and evidence of such investigations?; is this evidence sufficient to strengthen or modify the current treatment patterns? Our objective is to rate and analize these investigations; assessing the structure, the level of evidence, journals, authors, field of study and cosistency with initial objectives.

Methods: A quantitative –descriptive study of articles indexed in the CUIDEN data base, entering “pressure ulcers” as a search term, over the period stretching from January 1999 to December 2003. Items obtained were critically read and their level of evidence was analyzed using as a reference the texts and materials supplied in F.P. García Fernández’s and P.L. Pancorbo Hidalgo’s course on evidence based nursing.

Results: The search of the terms “pressure ulcers” in the CUIDEN data base produced 242 articles. Of these, 85 were selected and subsequently classified as original papers (62), case reports (2), editorials (4), letters to the director (1), communications (4), clinical practice guidelines, CPG (12). Our analysis focused on the original papers, which represented 72.94% of the search results. Of these, 22.95% of the papers failed to present an structured summary. As for the quality of the evidence, the level of evidence was A or high in 6.55% of the papers, B or medium in 18.03% of the papers and C or low in 76.68% of the papers. The author included a statement of opinion in 13.11% of the papers. As for the conclusion/discussion, 13.11% of the articles lacked consistency with the objectives. Results were not compared with those of other studies in 40.98% of the papers and 9.83% of them did not produce results that justified the conclusions. Regarding the journals of publication, the papers appeared in Gerokomos, 35.48%; Rol, 19.35% and Metas, 6.45%. Geographically, publication was distributed in this way: Andalusia, 32.25%; Catalonia, 17.74% and Madrid, 14.51%. Overall, 85.48% of the authors were nurses and 3.22% were MDs. Secondary care accounted for 74.19% of the authorship, a total of 12.90% was primary care, 1.61% of the papers were signed by social workers and 9.67% were authored by primary and secondary care professionals jointly.

Discusion: Methods used in research on PU are fundamentally rated as providing a C level of evidence, which is insufficient to strengthen or modify treatment patterns. We found that numerous reports produce conclusions that are not consistent with the objectives initially set out. No comparison with other studies is provided in a high percentage of papers. The investigators are nursing staff working in secondary care sites located in Andalusia, Catalonia and Madrid. Gerokomos continues to be a corner stone in the publication of original papers on PU. Over the last five years, research has experienced a linear progression.

KEY WORDS

Pressure ulcers, scientific evidence, research.

Vol. 16 nº1-2005