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2. What is the cost-effectiveness of foam mattresses, foam overlays, air filled sacs and low air loss surfaces for prevention of decubitus ulcers for patients in acute care and critical care?


A limited literature search was conducted on key health technology assessment (HTA) resources, including PubMed, The Cochrane Library (Issue 4, 2007), University of York Centre for Reviews and Dissemination (CRD) databases, ECRI, EuroScan, international HTA agencies, and a focused Internet search. Results include articles published between 2000 and the present, and are limited to English language publications only. Filters were applied to limit the retrieval to systematic reviews, meta-analyses, health technology assessments and randomized controlled trials (RCTs). Guidelines, observational studies and non-randomized trials (with or without a control group) were not included in the summary of findings.

Summary of findings:

Systematic reviews

Three systematic reviews have been retrieved3,6,7

, including a total of 12 RCTs published from

2000 and onward.8-18 For the studies that compared support surfaces, Reddy et al.3 concluded that they were appropriate strategies to prevent PUs (no specific percentages, relative risk (RR) or other types of results were available in the report). The Cochrane systematic review7 had only 5 recent studies. Cullum et al. found that foam alternatives to the standard hospital foam mattresses can reduce the incidence of PUs in people at risk. Pressure relieving overlays on the operating table have been shown to reduce postoperative PU incidence. The reviewers concluded that consideration should be given to the use of higher specification foam mattresses rather than standard hospital foam mattresses. The last systematic review completed by Nicosia et al.6 concluded that pressure-reducing/relieving surfaces were associated with a significantly lower incidence of heel ulcers compared with standard hospital mattresses (RR = 0.50, 95% CI = 0.26-0.93, P < 0.03). Foam mattresses also significantly reduced the risk of developing heel ulcers. There was evidence to support the use of certain air or foam mattresses/overlays in the prevention of heel PUs when compared with a standard hospital mattress. The information pertaining to studies published from 2000 and forward in these systematic reviews is summarized in Table 1.

Table 1: Summary of systematic reviews


Population (number



of trials)


Reddy 2006 3

Any patien setting (59 RCTs)

t care

43 RCTs assessed mattresses or overlays in acute or critical care. 8 studies were published from year 2000 and forward.

Any intervention to prevent PUs. The interventions targeting impaired mobility

included specialized mattresses, beds and cushions.

Of the studies in acute care, only two (Jolley et al. 200412 and Theaker et al. 200510) detected a significant reduction in the incidence of PUs. Jolley et al.12 compared specialized sheepskin overlay and standard hospital mattress. (N=441) Theaker et al.10 compared low-air-loss mattress versus alternating-pressure mattress (N=62)

Specialty Mattresses for Prevention of PUs in Acute and Critical Care


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