Risk factors associated with heel pressure ulcer development in adult population: A systematic literature review

Alisen Dube; Viola Sidambe; Amy Verdon; Eloise Phillips; Sarahjane Jones; Maxine Lintern; Mark Radford

doi:10.1016/j.jtv.2021.10.007

Risk factors associated with heel pressure ulcer development in adult population: A systematic literature review

J Tissue Viability. 2022 Feb;31(1):84-103. doi: 10.1016/j.jtv.2021.10.007. Epub 2021 Oct 28.

Authors

Alisen Dube¹, Viola Sidambe², Amy Verdon², Eloise Phillips³, Sarahjane Jones⁴, Maxine Lintern⁵, Mark Radford⁶

Affiliations

¹ Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK; School of Health, Science, and Wellbeing, Staffordshire University, Staffordshire, UK; University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK. Electronic address: alisen.dube@staffs.ac.uk.
² University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.
³ School of Pharmacy, Aston University, Birmingham, UK.
⁴ School of Health, Science, and Wellbeing, Staffordshire University, Staffordshire, UK.
⁵ Faculty of Business, Law and Social Sciences, Birmingham City University, Birmingham, UK.
⁶ Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK; Health Education England, Birmingham, UK; NHS England and NHS Improvement, Birmingham, UK.

PMID: 34742635
DOI: 10.1016/j.jtv.2021.10.007

Abstract

Aims: The main aim of this systematic literature review was to identify risk factors for development of heel pressure ulcers and quantify their effect.

Background: Pressure ulcers remain one of the key patient safety challenges across all health care settings and heels are the second most common site for developing pressure ulcers after the sacrum.

Design: Quantitative systematic review.

Methods: Data sources: Electronic databases were searched for studies published between 1809 to March 2020 using keywords, Medical Subject Headings, and other index terms, as well as combinations of these terms and appropriate synonyms.

Study eligibility criteria: Previous systematic literature reviews, cohort, case control and cross-sectional studies investigating risk factors for developing heel pressure ulcers. Only articles published in English were reviewed with no restrictions on date of publication.

Participants: patients aged 18 years and above in any care setting. Study selection, data extraction, risk of bias and quality assessment were completed by two independent reviewers. Disagreements were resolved by discussion.

Results: Thirteen studies met the eligibility criteria and several potential risk factors were identified. However, eligible studies were mainly moderate to low quality except for three high quality studies.

Conclusions: There is a paucity of high quality evidence to identify risk factors associated with heel pressure ulcer development. Immobility, diabetes, vascular disease, impaired nutrition, perfusion issues, mechanical ventilation, surgery, and Braden subscales were identified as potential risk factors for developing heel pressure ulcers however, further well-designed studies are required to elucidate these factors. Other risk factors may also exist and require further investigation.

Prospero id: PROSPERO International prospective register of systematic reviews: CRD42017071459.

Keywords: Adults; Contributory factors; Heel; Literature review; Nursing; Predictors; Pressure ulcer; Risk factors; Systematic review.

Publication types

Systematic Review

MeSH terms

Adolescent
Adult
Cross-Sectional Studies
Heel
Humans
Pressure Ulcer* / epidemiology
Pressure Ulcer* / etiology
Risk Factors