title: Comparison of air-fluidized therapy with other support surfaces used to treat pressure ulcers in nursing home residents.
abstract: To provide empirical evidence comparing pressure ulcer healing rates between different support surfaces, data were analyzed from eligible residents with pressure ulcers (N = 664) enrolled in the National Pressure Ulcer Long-Term Care Study, a retrospective pressure ulcer prevention and treatment study. Support surfaces were categorized as: Group 1 (static overlays and replacement mattresses), Group 2 (low-air-loss beds, alternating pressure, and powered/non-powered overlays/mattresses), and Group 3 (air-fluidized beds). Calculation of healing rates, using the largest ulcer from each resident, found mean healing rates greatest for air-fluidized therapy (Group 3) (mean = 5.2 cm(2)/week) versus Group 1 (mean =1.5 cm(2)/week) and Group 2 (mean = 1.8 cm(2)/week) surfaces (P = 0.007). Healing rates also were assessed using 7- to 10-day "episodes"; each ulcer generated separate episode(s) that included all ulcers when residents had multiple ulcers. Mean healing rates were significantly greater for Stage III/IV ulcers on Group 3 surfaces (mean = 3.1 cm(2)/week) versus Group 1 (mean = 0.6 cm(2)/week) and Group 2 (mean = 0.7 cm(2)/week) surfaces (Group 2 versus Group 3: P = 0.0211). This finding persisted for ulcers with comparable initial baseline areas (20 cm(2) to 75 cm(2)) on Group 2 and Group 3 surfaces; healing improved on Group 3 surfaces (+2.3 cm(2)/week) versus Group 2 surfaces (-2.1 cm(2)/week, P = 0.0399). Residents on Group 3 (6 out of 82; 7.3%) and Group 1 (47 out of 461; 10.2%) surfaces had fewer hospitalizations and emergency room visits than those on Group 2 surfaces (23 out of 121; 19.0%, P = 0.01) despite significantly greater illness in residents on Group 2 and 3 versus Group 1 surfaces (P is less than 0.0001). Despite limitations inherent in retrospective studies, ulcers on Group 3 surfaces versus Groups 1 and Group 2 surfaces had statistically significant faster healing rates (particularly for Stage III/IV ulcers) with significantly fewer hospitalizations and emergency room visits (Group 3 versus Group 2), despite significantly more illness in residents on Group 2 or Group 3 versus Group 1 surfaces. Episode analyses -- providing greater power, uniform treatment duration, and comparable baseline sizes -- confirmed these findings. Air-fluidized support surfaces represent great healing potential that justifies further exploration.
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA. rfochsross@aol.com
authors.forename: Rachel F
authors.initials: RF
authors.lastname: Ochs
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
authors.forename: Lia
authors.initials: L
authors.lastname: van Rijswijk
authors.forename: Catherine
authors.initials: C
authors.lastname: Pietsch
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Smout
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001513:Beds; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D003668:Pressure Ulcer / Q000473:pathology / Q000628:therapy*; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D014945:Wound Healing