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Journal Article•DOI•

Alginate dressings for treating pressure ulcers

Jo C Dumville1, Samantha Keogh2, Zhenmi Liu1, Nikki Stubbs3, Rachel Walker2, Mathew Fortnam4 •
University of Manchester1, Griffith University2, Leeds Community Healthcare NHS Trust3, University of York4
21 May 2015-Cochrane Database of Systematic Reviews (John Wiley & Sons, Ltd)-Vol. 2015, Iss: 5
TL;DR: The relative effects of alginate dressings compared with alternative treatments are unclear and decision makers may wish to consider aspects such as cost of dressings and the wound management properties offered by each dressing type, for example, exudate management.
Abstract: Background: Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers. This review is part of a suite of Cochrane reviews investigating the use of dressings in the treatment of pressure ulcers. Each review will focus on a particular dressing type. Objectives: To assess the effects of alginate dressings for treating pressure ulcers in any care setting. Search methods: For this review, in April 2015 we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication. Selection criteria: Published or unpublished randomised controlled trials (RCTs) comparing the effects of alginate with alternative wound dressings or no dressing in the treatment of pressure ulcers (stage II or above). Data collection and analysis Two review authors independently performed study selection, risk of bias assessment and data extraction. Main results: We included six studies (336 participants) in this review; all studies had two arms. The included studies compared alginate dressings with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy. Each of the six comparisons included just one study and these had limited participant numbers and short follow-up times. All the evidence was of low or very low quality. Where data were available there was no evidence of a difference between alginate dressings and alternative treatments in terms of complete wound healing or adverse events. Authors' conclusions: The relative effects of alginate dressings compared with alternative treatments are unclear. The existing trials are small, of short duration and at risk of bias. Decision makers may wish to consider aspects such as cost of dressings and the wound management properties offered by each dressing type, for example, exudate management.

Summary (1 min read)

Jump to: [Background] – [Main results] and [Authors’ conclusions]

Background

  • Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both.
  • Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings.
  • A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers.
  • Each review will focus on a particular dressing type.

Main results

  • The authors included six studies (336 participants) in this review; all studies had two arms.
  • The included studies compared alginate dressings with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy.
  • Each of the six comparisons included just one study and these had limited participant numbers and short follow-up times.
  • All the evidence was of low or very low quality.
  • 1Alginate dressings for treating pressure ulcers Copyright © 2015 The Cochrane Collaboration.

Authors’ conclusions

  • The relative effects of alginate dressings compared with alternative treatments are unclear.
  • Pressure ulcers can be painful, may become infected, and so affect people’s quality of life.
  • Generally, the studies the authors found did not have many participants and the results were often inconclusive.
  • More research of better quality is needed to find out if alginate dressings are better at healing pressure ulcers than other types of dressings or other treatments.
  • The mean reduction in ulcer size (compared to baseline) was 42.5%.

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Content maybe subject to copyright    Report

Alginate dressings for treating pressure ulcers (Review)
Author
Dumville, Jo C, Keogh, Samantha J, Liu, Zhenmi, Stubbs, Nikki, Walker, Rachel M, Fortnam,
Mathew
Published
2015
Journal Title
Cochrane Database of Systematic Reviews
Version
Version of Record (VoR)
DOI
https://doi.org/10.1002/14651858.CD011277.pub2
Copyright Statement
© 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This review is
published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2015,
Issue 5. Cochrane Reviews are regularly updated as new evidence emerges and in response
to comments and criticisms, and the Cochrane Database of Systematic Reviews should be
consulted for the most recent version of the Review.
Downloaded from
http://hdl.handle.net/10072/81471
Griffith Research Online
https://research-repository.griffith.edu.au
Cochrane Database of Systematic Reviews
Alginate dressings for treating pressure ulcers (Review)
Dumville JC, Keogh SJ, Liu Z, Stubbs N, Walker RM, Fortnam M
Dumville JC, Keogh SJ, Liu Z, Stubbs N, Walker RM, Fortnam M.
Alginate dressings for treating pressure ulcers.
Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No.: CD011277.
DOI: 10.1002/14651858.CD011277.pub2.
www.cochranelibrary.com
Alginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
T A B L E O F C O N T E N T S
1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . . . . . . . . . . . . . . . . . . .
5BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Figure 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Figure 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
20ADDITIONAL SUMMARY OF FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . .
28DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29AUTHORS’ CON CLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46ADDITIONAL TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
55CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
55DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56DIFFERENCES BETWEEN PROTOCOL AND REVIEW . . . . . . . . . . . . . . . . . . . . .
56INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
iAlginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Colla boration. Published by John Wiley & Sons, Ltd.
[Intervention Review]
Alginate dressings for treating pressure ulcers
Jo C Dumville
1
, Samantha J Keogh
2
, Zhenmi Liu
1
, Nikki Stubbs
3
, Rachel M Walker
2
, Mathew Fortnam
4
1
School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
2
NHMRC Centre of Research Excellence
in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
3
Wound Prevention and Management Service, Leeds Community Healthcare NHS Trust, St Mary’s Hospital, Leeds, UK.
4
Cochrane
Wounds Group, University of York, York, UK
Contact address: Jo C Dumville, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, M13 9PL,
UK.
jo.dumville@manchester. ac.uk.
Editorial group: Cochrane Wounds Group.
Publication s tatus and date: New, published in Issue 5, 2015.
Review content assessed as up-to-date: 14 April 2015.
Citation: Dumville JC, Keogh SJ, Liu Z, Stubbs N, Walker RM, Fortnam M. Alginate dressings for treating pressure ulce r s. Cochrane
Database of Systematic Reviews 2015, Issue 5. Art. No.: CD011277. DOI: 10.1002/14651858.CD011277.pub2.
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
A B S T R A C T
Background
Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying
tissue, or both. Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings.
A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of
pressure ul cers. This review is part of a suite of Cochrane reviews investigating the use of dressings in the treatment of pressure ulcers.
Each review will focus on a particular dressing type.
Objectives
To assess the effects of alginate dressings for treating pressure ulce r s in any care setting.
Search methods
For this review, in April 2015 we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane
Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other
Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication.
Selection criteria
Published or unpublished randomised controlled trials (RCTs) comparing the effects of alginate with alternative wound dressings or
no dressing in the treatment of pressure ulcers (stage II or above).
Data collection and analysis
Two review authors independently performed study selection, risk of bias assessment and data extraction.
Main results
We included six studies (336 participants) in this review; all studies had two arms. The included studies compared alginate dressings
with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy. Each of
the six comparisons included just one study and these had limited participant numbers and short follow-up times. All the evidence was
of low or very low quality. Where data were available there was no evidence of a diff erence between alginate dressings and alternative
treatments in terms of complete wound healing or adverse events.
1Alginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Colla boration. Published by John Wiley & Sons, Ltd.
Authors’ conclusions
The relative effects of alginate dressings compared with alternative treatments are unclear. The existing trials are small, of short duration
and at risk of bias. Decision makers may wish to consider aspects such as cost of dressings and the wound management properties
offered by each dressing type, for example, exudate management.
P L A I N L A N G U A G E S U M M A R Y
Alginate dressings for treating pressure ulcers
What are pressure ulcers, and who is at risk?
Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are wounds involving the skin and sometimes the
tissue th at lies underneath. Pressure ulcers can be painful, may become infected, and so affect people’s quality of life. People at risk of
developing pressure ulcers include those with spinal cord injuries, and those who are immobile or who have limited mobility - such as
elderly people and people who are ill as a result of short-term or long-term medical conditions.
In 2004 the total annual cost of treating pressure ulcers in the UK was estimated as being GBP 1.4 to 2.1 billion, which was equivalent
to 4% of the total National Health Service expenditure. Pe ople with pressure ulcers have longer stays in hospital, and this increases
hospital costs. Figures from th e USA for 2006 suggest that hal f a million hospital stays had ’pressure ulcer’ noted as a diagnosis; the
total hospital costs of these stays was USD 11 billion.
Why use alginate dressings to treat pressure ulcers?
Dressings are one treatment option for pressure ulcers. There are many types of dressings that can be used; these can vary considerably
in cost. Alginate dressings are a type that is highly absorbant and so can absorb the fluid (exudate) that is produced by some ulcers.
What we found
In June 2014 we searched for as many relevant studies as we could find that had a robust design (randomised controlled trials) and
compared alginate dressings with other treatments for pressure ulcers. We found 6 studies involving a total of 336 participants. Alginates
have been compared with hydrocolloid dressings, another type of alginate dressing, dextranomer paste dressing, silver-alginate dressing,
silver-zinc sulfadiazine cream and treatment with a radiant heat system in these studies. There was no evidence from these studies to
suggest that alginate wound dressings are more effective at healing pressure ulcers than other types of dressings or skin surface (topical)
treatments, or other interventions.
Generally, the studies we found did not have many participants and the results were often inconclusive. Some study reports did not
provide information about how they were conducted and it was difficult to tel l whether the results presented were likely to be true.
More research of better quality is needed to find out if alginate dressings are better at healing pressure ulcers than other types of dressings
or other treatments. This review is part of a suite of reviews investigating dressings for the treatment of pressure ulcers
This plain language summary is up-to-date as of June 2014.
2Alginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Colla boration. Published by John Wiley & Sons, Ltd.
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Frequently Asked Questions (6)
Q1. What are the types of people at risk of developing pressure ulcers?

People at risk of developing pressure ulcers include those with spinal cord injuries, and those who are immobile or who have limited mobility - such as elderly people and people who are ill as a result of short-term or long-term medical conditions. 

In 2004 the total annual cost of treating pressure ulcers in the UK was estimated as being GBP 1.4 to 2.1 billion, which was equivalent to 4% of the total National Health Service expenditure. 

Published by John Wiley & Sons, Ltd.A B S T R A C TPressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. 

Figures from the USA for 2006 suggest that half a million hospital stays had ’pressure ulcer’ noted as a diagnosis; the total hospital costs of these stays was USD 11 billion. 

For this review, in April 2015 the authors searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. 

GRADE Working Group grades of evidence High quality: further research is very unlikely to change their confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on their confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on their confidence in the estimate of effect and is likely to change the estimate Very low quality: the authors are very uncertain about the estimate1