Risk assessment tools for the prevention of pressure ulcers.

BACKGROUND Pressure ulcer risk assessment is a component of the assessment process used to identify individuals at risk of developing a pressure ulcer. Use of a risk assessment tool is recommended by many international pressure ulcer prevention guidelines however it is not known whether using a risk assessment tool makes a difference to patient outcomes. A review was conducted to clarify the role of pressure ulcer risk assessment in clinical practice. OBJECTIVES The objective of this review was to determine whether using structured, systematic pressure ulcer risk assessment tools, in any health care setting, reduces the incidence of pressure ulcers. SEARCH STRATEGY The following databases were searched: MEDLINE (January 1966 to April Week 3, 2008); EMBASE (1974 to Week 17, 2008); CINAHL (1982 to April Week 4, 2008); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, issue 2, 2008); The Wounds Group Specialised Register (searched 29/4/2008). There were no restrictions on articles on the basis of language or date of publication. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the use of structured, systematic, pressure ulcer risk assessment tools with no structured pressure ulcer risk assessment, or with unaided clinical judgement, or RCTs comparing the use of different structured pressure ulcer risk assessment tools were considered for this review. DATA COLLECTION AND ANALYSIS Titles and, where available, abstracts of the studies identified by the search strategy were assessed by two authors independently for their eligibility. Full versions of potentially relevant studies were obtained and screened against the inclusion criteria by two authors independently. MAIN RESULTS No studies were identified that met the inclusion criteria. AUTHORS' CONCLUSIONS Despite the widespread use of risk assessment tools for the assessment of individuals' risk of developing pressure ulcers, no randomised trials exist that compare them with unaided clinical judgement or no risk assessment in terms of rates of pressure ulceration. Therefore, we cannot conclude whether the use of structured, systematic pressure ulcer risk assessment tools, in any health care setting, reduces the incidence of pressure ulcers. The effect of structured risk assessment tools on pressure ulcer incidence needs to be evaluated.