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Debridement of Chronic Wounds: a Systematic Review

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Debridement of Chronic Wounds: a Systematic Review Health Technology Assessment 1999; Vol. 3: No. 17 (Pt 1) Review The debridement of chronic wounds: a systematic review M Bradley N Cullum T Sheldon Health Technology Assessment NHS R&D HTA Programme HTA HTA How to obtain copies of this and other HTA Programme reports. An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (http://www.hta.ac.uk). A fully searchable CD-ROM is also available (see below). Printed copies of HTA monographs cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our Despatch Agents. Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph. 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The debridement of chronic wounds: a systematic review M Bradley1* N Cullum2 T Sheldon3 1 NHS Centre for Reviews and Dissemination, University of York,UK 2 Centre for Evidenced Based Nursing, University of York,UK 3 York Health Policy Group, University of York,UK * Corresponding author Competing interests: none declared Published September 1999 This report should be referenced as follows: Bradley M, Cullum N, Sheldon T. The debridement of chronic wounds: a systematic review. Health Technol Assess 1999;3(17 Pt 1). Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA web site (see overleaf). NHS R&D HTA Programme he overall aim of the NHS R&D Health Technology Assessment (HTA) programme is to T ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources. The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA). This report is one of a series covering acute care, diagnostics and imaging, methodology, pharmaceuticals, population screening, and primary and community care. It was identified as a priority by the Pharmaceutical Panel and funded as project number 93/29/01. The views expressed in this publication are those of the authors and not necessarily those of the Standing Group, the Commissioning Board, the Panel members or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for the recommendations for policy contained herein. In particular, policy options in the area of screening will be considered by the National Screening Committee. This Committee, chaired by the Chief Medical Officer, will take into account the views expressed here, further available evidence and other relevant considerations. Reviews in Health Technology Assessment are termed ‘systematic’ when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. Series Editors: Andrew Stevens, Ruairidh Milne and Ken Stein Editorial Assistant: Melanie Corris The editors have tried to ensure the accuracy of this report but cannot accept responsibility for any errors or omissions. They would like to thank the referees for their constructive comments on the draft document. ISSN 1366-5278 © Crown copyright 1999 Enquiries relating to copyright should be addressed to the NCCHTA (see address given below). Published by Core Research, Alton, on behalf of the NCCHTA. Printed on acid-free paper in the UK by The Basingstoke Press, Basingstoke. Copies of this report can be obtained from: The National Coordinating Centre for Health Technology Assessment, Mailpoint 728, Boldrewood, University of Southampton, Southampton, SO16 7PX, UK. Fax: +44 (0) 1703 595 639 Email: [email protected] http://www.hta.nhsweb.nhs.uk Health Technology Assessment 1999; Vol. 3: No. 17 (Pt 1) Contents List of abbreviations .................................... i Acknowledgements ...................................... 25 Executive summary ..................................... iii References ..................................................... 27 1 Introduction .................................................. 1 Appendix 1 MEDLINE search strategy ....... 31 Mechanical debridement ............................... 1 Non-mechanical debridement ...................... 2 Appendix 2 CINAHL and EMBASE 2 Methods ......................................................... 3 search strategy ................................................. 33 Literature search ............................................ 3 Study selection and data extraction .............. 3 Appendix 3 Additional databases Data synthesis ................................................. 3 searched .......................................................... 35 Assessment of outcome measures ................. 3 Appendix 4 Expert advisory panel .............. 37 3 Results ............................................................ 7 Debriding agents versus traditional or Appendix 5 Quality assessment ................... 39 control therapy ............................................... 7 Comparisons between debriding agents ....... 9 Appendix 6 Summary of studies ................. 41 Cost-effectiveness ............................................ 9 4 Discussion ...................................................... 19 Health Technology Assessment reports published to date .......................................... 71 5 Conclusions ................................................... 23 Implications for policy ................................... 23 Health Technology Assessment Recommendations for research .................... 23 panel membership ........................................ 75 Health Technology Assessment 1999; Vol. 3: No. 17 (Pt 1) List of abbreviations C comparator* I intervention* CI confidence interval CRD Centre for Reviews and Dissemination ES effect size F female* HTA Health Technology Assessment ITT intention-to-treat M male* NS not significant* OR odds ratio RCT randomised controlled trial SD standard deviation* SEM standard error of the mean* * Used only in tables and figures i Health Technology Assessment 1999; Vol. 3: No. 17 (Pt 1) Executive summary Background Interventions The following interventions were identified as A wide variety of debridement methods and agents that would be used primarily for wound products are available, all of which have diverse debridement. properties, costs and levels of acceptability. There is currently wide variation in their use and a lack of • Dextranomer polysaccharide beads or paste consensus on how to treat specific wound types. • Cadexomer iodine polysaccharide beads or paste • Hydrogels Objectives • Enzymatic agents • Adhesive zinc oxide tape • To summarise the evidence for the relative • Surgery or sharp debridement effectiveness and cost-effectiveness of different • Larval (maggot) therapy. debriding agents on wound healing. • To identify areas for future research. Other interventions that are believed to have a debriding function, such as hydrocolloid dressings and antibiotics/antiseptics, were not included in Methods this review as debridement was not
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