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PubMed2003

[Use of risk scales for decubitus ulcers as screening instruments--A systematic review of external evidence].

CONTEXT: Reports on the preventive effects of scales to measure the risk of decubitus ulcer development of patients in various care settings have been inconsistent. The value of the different tools as screening instruments for risk factors as one step of a screening program has not yet been evaluated. OBJECTIVE: To evaluate the prognostic validity of scales measuring the risk of decubitus ulcer development. DATA SOURCES: Studies published in English or German and reporting trials of validity and reliability of scales measuring the risk of decubitus ulcer of patients in any care setting were identified through searches of Medline and CINAHL, Carelit and Heklinet (1981-2000). Reference lists of earlier reviews were checked. STUDY SELECTION: 257 abstracts were screened; 43 publications were assessed initially, 24 publications were analysed after exclusion criteria have been applied. DATA EXTRACTION: Abstracts were screened and data on study objective, scale, cut-off, follow-up, population, setting, sensitivity and specificity, trial quality including blinding, reference standard and outcome measurement were assessed. DATA SYNTHESIS: 24 studies analysed five instruments. Due to heterogeneity in study design, methodological quality and outcome assessment pooling of data was not feasible. Only data on the Braden Scale allowed the calculation of likelihood ratios for each point of the scale. Likelihood ratios for the Braden Scale were moderate [LR+ 0.3-7.7 (Cut-off 16)], and fair for the Norton Scale [LR+ 1.4-2.8 (Cut-off 14)]. CONCLUSION: The tools investigated as instruments of primary prevention of decubitus ulcers show that their test performance is inadequate. Thus, they are unlikely to be effective as screening instruments for any institutionalised patient group and care setting.

Humans↗
PubMed1991

Topical metronidazole gel. The bacteriology of decubitus ulcers.

Ten putrid-smelling decubitus ulcers were successfully treated with metronidazole gel. Anaerobes were cultured from five ulcers and Wood's light examination was positive in four ulcers before treatment. The odor was eliminated after 36 hours of therapy. All results of post-treatment cultures of anaerobes and Wood's light examinations were negative.

Administration, Topical↗
PubMed1975

Collagenase in the treatment of dermal and decubitus ulcers.

The current management of decubitus ulcers, factors in wound healing and the role of enzymes in treatment are discussed. The therapeutic benefits of collagenase (Santyl) ointment in 21 patients are described, supplemented by serial color photographs. Statistical evidence is provided for the conclusion that collagenase ointment is an excellent adjunct to therapy.

Adult↗
PubMed1996

Magnetic resonance imaging examinations of gluteal decubitus ulcers in spinal cord injury patients.

The purpose of our study was to use magnetic resonance imaging (MRI) to determine deep changes in soft tissues and bones underlying decubitus ulcers which occur in spinal cord injury (SCI) patients. By diagnosing these deep changes adjacent to decubitus ulcers, MRI can facilitate proper clinical management and prevent contraindicated surgery. MRI evaluation was performed on 37 male SCI patients for a total of 44 diagnostic studies. The studies were evaluated by the following criteria: 1) the presence of an adjacent fluid collection, 2) bone involvement raising the possibility of osteomyelitis and 3) heterotopic bone formation. Results demonstrated 11 patients (29.7 percent) with fluid collection in the deep soft tissues underlying the decubitus ulcer and eight patients (21.6 percent) with abnormal adjacent bone marrow signal. Four patients (10.8 percent) had heterotopic bone formation near the ulcer. We conclude that MRI is helpful in determining the depth and extent of soft tissue involvement underlying decubitus ulcers including underlying fluid collections, heterotopic bone formation and evidence of adjacent bone marrow edema. This is beneficial in planning proper therapy.

Adult↗
PubMed1990

Irrigation-aspiration for culturing draining decubitus ulcers: correlation of bacteriological findings with a clinical inflammatory scoring index.

Biopsy of infected decubitus ulcers for culture disrupts tissues and may disseminate infection. Antimicrobial prophylaxis to prevent dissemination of infection may adversely affect biopsy culture results. Irrigation-aspiration to obtain submarginal specimens from draining decubitus ulcers was studied as an atraumatic, noninvasive culturing technique to serve as an alternative to biopsy in research activities. Two aspirates were obtained serially from 32 subjects; in 12 subjects, biopsies were also performed immediately. A median of 4.5 bacterial species was recovered per ulcer by irrigation-aspiration. Recent antimicrobial treatment had no evident effect on the recovery of bacterial species in general or, specifically, on the recovery of Bacteroides species. Concordance of results for both aspirates was 97.6% for aerobes and 91.8% for anaerobes, indicating no interactive methodological effect of the first irrigation-aspiration on the second. Compared with biopsy isolates for one aspirate, the sensitivity was 93% and the specificity was 99.0%; for another aspirate, the sensitivity was 94.7% and the specificity was 99.5%. The positive predictive value for either aspirate was greater than or equal to 93.9%. A weighted clinical index to score inflammatory ulcer characteristics was devised (score range, 0 to 15). In the absence of anaerobes in 15 subjects, the mean score was 6.1 +/- 3.5; in the presence of anaerobes in 17 subjects, the mean score was 9.4 +/- 3.2 (P = 0.008). The presence of aerobic gram-positive or gram-negative species did not significantly affect scores. Irrigation-aspiration for culture and clinical scoring of inflammation should permit independent serial measures of bacteriological and clinical courses of draining decubitus ulcers without patient risk or discomfort.

Aged↗
PubMedDate not supplied

Topical application of insulin in decubitus ulcers.

When a pilot study provided evidence that insulin may increase the rate of healing of decubitus ulcers, this study attempted to answer the question: Is topical insulin therapy an effective treatment regimen for decubitus ulcers? The experimental study utilized a two-group, before-after design. Twenty-nine geriatric subjects were randomly assigned to either the experimental or the control group. The single independent variable was the topical application of ten units of regular insulin (U.S.P.) twice daily. The dependent variable was the surface area of the decubitus ulcer measured in square millimeters. Rate of healing was defined as decrease in surface area over time. Data were also gathered on extraneous variables believed to influence the healing process. The F test was used to test the research hypothesis that experimental subjects would have an increased rate of healing. When comparison of group means on day seven and day 15 revealed no significant differences, the research hypothesis was rejected. Pearson product moment correlation procedures were utilized to determine if there were differences between extraneous variables and the rate of healing. Females healed significantly (p less than .05) more slowly than males. Also, there was a direct correlation between the number of days of treatment and the rate of healing.

Drug Evaluation↗
PubMed1987

Bilateral hip disarticulation in paraplegics with decubitus ulcers.

A small percentage of paraplegic patients develop chronic decubitus ulcers that are unresponsive to the usual plastic surgical maneuvers. We used anatomic and nonanatomic (filleting) approaches to hip disarticulation in three patients with severe chronic cavernous decubitus ulcers. All patients were rehabilitated to wheelchair ambulation, with subsequent healing of the operative sites. This type of therapy might be considered in paraplegics with less compelling reasons for amputation, because of the associated rehabilitation potential.

Colostomy↗
PubMed2002

[The influence of complications on rehabilitation of spinal cord injuries: economical minus effects and physical disadvantages caused by urinary tract infection and decubitus ulcer].

There are few studies on the many complications that disrupt the rehabilitation of patients with cervical cord injuries and their subsequent health-economic benefits. I particularly focused on the treatment of urinary tract infection and decubitus ulcers because these are very frequently encountered complications in a clinical setting. I examined how these complications affect the progress of rehabilitation and facilitate a patient's return to society. The subjects included ninety-eight cervical cord injury patients with tetraplegia who were discharged from the Rehabilitation Center for Severely Disabled Persons from 1995 to 2000. I retrospectively investigated these ninety-eight subjects regarding ninety-six items from clinical records, among which twenty items were selected because they are considered to be closely associated with outcome, such as age, sex, length of stay, medical expense, urinary tract infection, and decubitus ulcer. Moreover, I examined the influence that urinary tract infection and decubitus ulcer had on other items. The average length of stay and total medical expenses per patient were 1,174.4 +/- 559.9 days and 13,563,128.4 +/- 6,351,078.1 yen, respectively. Urinary tract infection and decubitus ulcer occurred at a rate of 97% in patients with cervical cord injury undergoing chronic stage rehabilitation, and these complications caused a two-fold prolongation of the length of stay and a three-fold increase in medical expenses compared with patients without complications. It is important to fully recognize that these complications produce many expenses as well as those for the medical treatment of cervical cord injury.

Adolescent↗
PubMed1998

An evaluation of current risk assessment scales for decubitus ulcer in general inpatients and wheelchair users.

OBJECTIVES: To study the components of two risk assessment scales for decubitus ulcer risk, Waterlow and Braden, and of the Chailey score for the same purpose. DESIGN: Experimental study of patients at risk of developing decubitus ulcers. SETTING: The West Midlands and Yorkshire. SUBJECTS: One hundred and fifty wheelchair users from the West Midlands and 9022 patients from a District General Hospital in York, the latter consisting of all admissions to the hospital in a four-month period. INTERVENTIONS: Braden, Chailey scores (wheelchair users) and Waterlow scores (all subjects) measured. MAIN OUTCOME MEASURES: Development of a pressure sore, receiver operating characteristic (ROC) curves. RESULTS: Waterlow outperformed Braden for classification of wheelchair patients with respect to decubitus ulcer. The Chailey score performed randomly in this group. The sensitivity and specificity as seen in ROC curves was different for Waterlow scores for wheelchair users and general patients, the latter being much better classified. Only three items out of 11 in the Waterlow score appeared to have any classification ability in the wheelchair group. CONCLUSIONS: Risk indicators used for general patients are probably poorly suited for wheelchair users. There is a need for large-scale predictive studies of wheelchair users and other groups to allow regression analysis of the subscales of risk indicators. From the provisional data of this study it appears that splitting patients by gender and into full- and part-time wheelchair users classifies almost as well the much more complicated risk assessment tools currently available.

Case-Control Studies↗
PubMed1986

Recent findings on decubitus ulcer pathology: implications for care.

Vasodilators are ineffective therapy for decubitus ulcers because blood vessels are absent in the necrotic areas. Systemic application of vasodilating drugs actually decreases the nutritional blood flow through the damaged zone. Protracted healing of decubitus ulcers may be explained by an altered nutrient transport rate to the cells caused by fibrin thrombi in the capillaries and fibrin deposits in the intercellular space, resulting from decreased fibrinolytic activity.

Disinfectants↗
PubMed1976

[The bacterial flora of decubitus ulcers and the effects of ultraviolet light on this flora].

Decubitus ulcers, their treatment, the effect of UV light on bacterial flora of these ulcers, different effects of UV light according to the wave length, the UV lamp used in experiments, and the bacterial flora of wounds in different phases are explained. From 21 patients, with decubitus ulcers under UV treatment, 974 samples were collected before and after UV treatments. These samples were cultured on blood agar plates by the isolation method in 5 steps. After 24 hours incubation, the colonies were counted at each step and then identified. It has seen that bacterial flora decreased gradually from 1 MED, up to 6 MED of UV exposure. (MED = Minimal eritemal dose = about 1 minute) From 6 MED up to 20 MED the rate of decrease remained almost at the same level as in 6 MED. The number of colonies at each step before and after UV exposures were compared with each other. Only the averages of first steps in every MED, their standard errors and (P) values are shown in table III. The ulcers showed higher granulation tissue and faster healing parallel to the effect of UV light on bacteria. In cultures from 974 samples, pseudomonas was most commonly found, followed by diphtheroides, hemolytic staphylococci, non-hemolytic staphylococci, Gram (--) micrococci, proteus, mima (only in two patients), candida, saprophytic staphylococci, neisseria, haemophilus, and aerobic spore-forming bacilli.

Adolescent↗
PubMed1992

The management of decubitus ulcers by musculocutaneous flaps: a five-year experience.

Large decubitus ulcers can be treated by using many methods, including musculocutaneous flaps. Musculocutaneous flaps provide reliable, well-vascularized cover and often can be revised in patients with secondary recurrence. We have treated 30 patients with large decubitus ulcers during a 5-year period by using musculocutaneous advancement flaps of the gluteus maximus, the hamstring muscle, and the tensor fasciae latae. There were two complications treated by debridement with flap advancement in 1 patient and the use of another flap in the second patient. Four patients developed a recurrent ulcer, which was treated by reelevation and advancement of the original flap in all patients. The general management and overall results are presented.

Buttocks↗
PubMed1979

Decubitus ulcers: a comparative study.

Seventeen patients with thirty-four decubitus ulcers were treated with dextranomer, collagenase, or sugar and egg white. All seven patients in the dextranomer group and two of five patients in the collagenase group improved at the end of the study, but none of the five patients on sugar and egg white treatment improved. Although collagenase can be helpful in the treatment of decubitus ulcers, dextranomer is significantly better.

Adult↗
PubMed1983

Bacteremia associated with decubitus ulcers.

We studied 104 episodes of bacteremia in 102 patients with decubitus ulcers observed over five years in the hospitals of one metropolitan area. The ulcers were considered to be the "probable" source of bacteremia in 49% of episodes. Another site of infection was documented in 86% of patients. Proteus mirabilis, Staphylococcus aureus, and Escherichia coli were the most frequent blood isolates in these patients, but only Bacteroides species correlated with "probable" origin of bacteremia from the ulcers. The overall mortality was 55%, with 51% of deaths being attributed to infection. These findings emphasize the importance of decubitus ulcers as potential sources of bacteremia in hospitalized patients.

Adolescent↗
PubMed1991

[Decubitus ulcers in geriatrics--pathogenesis, prevention and therapy].

Magnitude and duration of interface pressure are the crucial etiological factors in the decubitus ulcer formation. Small amounts of interface pressure that exceed the average capillary pressure (range: 2.7 to 6.3 kPa) may lead to compression of the skin microcirculation and resultant tissue necrosis when a critical duration of interface pressure of more than 2 h is reached. The principles of decubitus ulcer prevention are derived from the pathophysiology of ulcer formation as noted: reduction of interface pressure below 3 kPa by bedding each at-risk patient on a 'super-soft' mattress and shortening the duration of interface pressure below 2 h. by turning of patients from the supine position to the right and left 30 degrees oblique back position every two hours. Decubitus ulcers typically show impaired wound healing. Conditions most conspicuously protracting normal wound healing are: tissue hypoxia, fibrin deposits, necrotic tissue, local infection, defective migration of keratinocytes, impaired general condition, etc. Based on these pathophysiological mechanisms, five therapeutical principles are proposed: complete relief of interface pressure, débridement of necrotic tissue, treatment of infection using systemical antibiotics, wet and air-permeable wound dressing, improvement of patient's general condition.

Aged↗
PubMed2004

Necrotizing soft tissue infection from decubitus ulcer after spinal cord injury.

STUDY DESIGN: A case of necrotizing soft tissue infection in a patient with spinal cord injury with extension of infection into the spinal canal and spinal cord is presented. OBJECTIVE: To review the history, risk factors, pathophysiology, diagnosis, treatment, and morbidity and mortality regarding necrotizing soft tissue infection as they relate to spinal cord injury. SUMMARY OF BACKGROUND DATA: Necrotizing soft tissue infection related to decubitus ulcers is rare. To our knowledge, this is the first report of this disease related to a sacral decubitus ulcer with extension of the necrotizing infection into the spinal canal. METHODS: The clinical, radiographic, and pathologic features associated with necrotizing soft tissue infection are presented. The patient presented with a late-stage necrotizing soft tissue infection requiring extensive de-bridement of necrotic tissue, which the patient underwent on admission. RESULTS: The patent died of refractory septic shock and multiple-organ failure after surgery. CONCLUSION: Necrotizing soft tissue infections from decubitus ulcers are rare and unpredictable, and ultimately have a progressively aggressive course. The case reported herein is the first report of necrotizing soft tissue infection from a decubitus ulcer in a patient with spinal cord injury with extension into the spinal canal and spinal cord.

Abdomen↗