Outcomes of 4 methods of debridement using a decision analysis methodology.
OBJECTIVE
To compare the clinical efficacy of 4 debridement alternatives in pressure ulcer management.


METHODS
Nonexperimental design combining computer modeling and a decision analysis methodology. Data input into the model were derived from a literature review of the MEDLINE database for the years 1985 to 1995 (indexing terms: pressure ulcer, decubitus, economics, cost-effectiveness, and outcome) and a Delphi consensus process with an independent panel of 9 specialists in geriatric care.


METHODS
Long-term care.


METHODS
Hypothetical elderly female resident with a new full-thickness pressure ulcer (mild odor, minimal draining, no undermining, intact periulcer skin).


METHODS
The study patient underwent 1 month of therapy with each of 4 debridement methods: autolysis, wet-to-dry dressings, collagenase (Santyl) or fibrinolysin (Elase).


RESULTS
Specific clinical outcomes (time to clean wound bed, risk of infection) and relative cost-effectiveness of each debridement method were calculated.


RESULTS
The likelihood of achieving a clean wound bed at 2 weeks was 70% for collagenase, 57% for fibrinolysin, 50% for autolysis, and 30% for wet-to-dry dressings. The total cost for 1 month of treatment was $610.96 for collagenase, $920.73 for autolysis, $986.38 for fibrinolysin, and $1,008.72 for wet-to-dry dressings.


CONCLUSIONS
The study patient was most likely to have a clean wound bed after 2 and 4 weeks of treatment, less likely to need to switch debridement methods, and of equal or less likelihood of experiencing and infection and subsequent hospitalization when her wound was debrided with collagenase. Treatment with collagenase also resulted in the lowest total cost of treatment. Longer term, prospective studies using actual utilization data are needed to refine these estimates of the clinical and cost-effectiveness of each product.
D000368:Aged; D001329:Autolysis; D001458:Bandages / Q000191:economics; D017364:Collagenases / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003646:Debridement / Q000191:economics / Q000379:methods*; D003661:Decision Support Techniques; D003697:Delphi Technique; D005260:Female; D005341:Fibrinolysin / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D003668:Pressure Ulcer / Q000451:nursing*; D016896:Treatment Outcome; D014945:Wound Healing