Prevention of Pressure Ulcers in Hip Fracture Patients

University Of Maryland Baltimore, Baltimore MD

Investigators

Linked publications & trials

Abstract

DESCRIPTION (provided by applicant): Pressure ulcers constitute an important clinical problem, both in terms of patient suffering and cost of care. The elderly patient undergoing hip surgery is at high risk for pressure ulcers by virtue of exposure to long periods of immobility before, during, and after surgery, and by virtue of exposure to friction and shearing injuries when being transferred to and from beds, stretchers, x-ray tables, and operating tables. Epidemiologic studies have established that the incidence of pressure ulcers in hip fracture patients is high. National panels have identified hip fracture patients as a high-risk group and have emphasized the urgent need for rigorous evaluations of promising preventive interventions in this patient population. We propose to evaluate a comprehensive intervention for the prevention of pressure ulcers in hip fracture patients. The intervention will involve the provision of pressure-reducing devices during the emergency department stay, in the operating room, and during the pre- and postoperative periods. The devices that are evaluated will relieve pressure both on the sacral area and the heels, will be for use on stretchers, beds, and chairs, and will be inexpensive and easy to use and maintain. The intervention will be evaluated using a rigorous randomized controlled trial (RCT) design. The primary aim of this RCT (which we will refer to as the "future trial") will be to determine whether the incidence of pressure ulcers is lower among hip fracture patients randomized to the preventive intervention than in patients randomized to usual care. Secondary aims will be to estimate the incremental cost-effectiveness of the intervention and to compare patients in the intervention and control groups with respect to patient-assessed comfort while lying and while seated. In the present application, we are requesting support for the planning and development of the future trial. The planning process will involve the analysis of existing data, the conduct of preliminary studies, and the development of detailed research protocols for the trial. At the end of the planning project, we will be poised to submit a proposal that applies rigorous research methods to an important clinical problem.