Research and Education Opportunities From A Content-Validated Pressure Ulcer Guideline

Rationale:  Consistent evidence-based care improves pressure ulcer (PU) incidence and outcomes. Current PU guidelines differ in scope, definitions, validation, evidence criteria and procedures recommended, potentially reducing consistency and quality of PU risk assessment, diagnosis, prevention, treatment and outcomes measurement.¹ Clarifying evidence strength and validating PU guideline recommendations may reduce confusion and improve consistency of PU care. Objective: The Association for the Advancement of Wound Care Guideline Department (AAWCGD) compiled recommendations from published PU guidelines and compared their content validity and evidence strength to identify strong recommendations and highlight opportunities for education and/or research. Methods:  The AAWCGD compiled 380 recommendations from ten pre-July-2008 AHRQ National Guideline Clearinghouse (NGC) PU guidelines, plus those of the NPUAP, EPUAP and Wound Healing Society. Thirty-one multidisciplinary AAWC-member survey respondents rated clinical relevance of each recommendation using a standardized 4-point judgment quantification scale. Content validity index (CVI) ≥ 0.75 validated a recommendation.  AAWCGD members tabulated recommendation CVI and standardized strength of best available MEDLINE-derived evidence.  Results: Most (72%) content-validated recommendations lacked strong evidence representing opportunities for research.  Twenty percent of the recommendations met both content validity and strong evidence criteria. Five percent of the  recommendations met neither evidence nor content validity criteria and will be dropped from the validated PU guideline freely accessible at the AAWC website aawconline.org, and submitted to NGC. Less than 2% of  the recommendations had strong evidence and CVI < 0.75, representing educational opportunities. Conclusion:  Content validity and supporting evidence for PU care recommendations highlight predominantly research and a few education opportunities to improve consistency and quality of PU management.