Volume 26 Number 3

Introduction

Pressure injuries (PIs) are areas of skin and tissue damage caused by prolonged pressure or a combination of pressure and shear forces.¹ Hospital-acquired pressure injuries (HAPIs) develop in hospital settings,² where patients face increased risk due to prolonged immobility, leading to reduced skin oxygenation and perfusion.^3,4 Additionally, prolonged contact with medical devices can cause medical device-related pressure injuries (MDRPIs), commonly observed in operating theatres, intensive care units (ICUs) and emergency departments (EDs).⁵ PIs affect patients across various patient groups and medical specialties,^3,5 reducing quality of life,⁶ prolonging hospital stays,⁷ and increasing stress,⁸ pain, infection, and mortality.⁹ The Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) classify HAPI a “never event”, a preventable medical error that should not occur. PI rates are considered a quality-of-care indicator in the United States of America (USA):^2,10 with hospitals facing financial penalties or incentives based on their performance in reducing PI rates.^10,11 Understanding PI prevalence and incidence is crucial for assessing disease burden and economic impact. The incidence rate refers to the number of new cases of a disease occurring in a population per unit of person-time, while cumulative incidence represents the proportion of individuals developing the condition over a specified period. Prevalence is the total number of cases (both new and existing) in a population at a given point (point-prevalence) or over a defined period (period prevalence).¹² These epidemiological metrics are essential for economic analyses, informing health policy and care pathway changes, and supporting Health Technology Assessment (HTA) submissions for new healthcare interventions.¹³

The aim of this systematic review (SR) was to obtain reliable estimates of PI prevalence or incidence in the USA to support targeted epidemiological and health economic analyses. Given the availability of multiple SRs and meta-analyses (MAs) on PI prevalence or incidence, we conducted an umbrella review (a review of SRs) to synthesise existing evidence in the USA.^14,15 We also assessed the feasibility of performing a meta-meta-analysis (meta-MA) — a meta-analysis of multiple meta-analyses — and evaluated the quality of published SRs and MAs. Unlike narrative reviews, MAs and meta-MAs generate quantitative estimates that can be used in health economic models for HTA submissions of new healthcare interventions.^16,17 Additionally, meta-MAs, which summarise effect sizes from existing meta-analyses,¹⁸ help minimise redundancy and enhance generalisability by providing a structured methodology to resolve inconsistencies across reviews.¹⁹ This approach allows for a more robust assessment of consistency, publication bias, and gaps in the literature,²⁰ but it is not always the appropriate methodology. A meta-MA requires sufficient methodological similarity among the included studies, such as a comparable research question and methodology, high-quality SRs and MAs, acceptable levels of heterogeneity, publication bias, and study overlap.^14,21,22

If a meta-MA was deemed infeasible due to excessive heterogeneity or methodological limitations, a narrative review was planned, along with a detailed assessment of quality issues in the included SRs and MAs. This quality assessment aimed to inform the design of future SRs and MAs, ultimately enhancing the impact of epidemiological research and economic modeling on policy development.

Methods

This SR was conducted following the Cochrane and the Centre for Reviews and Dissemination (CRD) guidelines,^19,23 and methodological guidance for umbrella reviews.²⁴ Reporting was aligned with the Preferred Reporting Items For Systematic Review And Meta-Analysis (PRISMA) Statement²⁵ (Figure 1). The methods for the umbrella review were described in a protocol registered on OSF (https://osf.io/y3xbz).

 

Figure 1. The PRISMA flow diagram

 

Eligibility criteria

To establish the SR eligibility criteria, we specified the inclusion and exclusion criteria in the protocol using the Population, Intervention, Comparator, Outcome, Study design (PICOS) format presented in Table 1.

The limits are due to pragmatic and methodological reasons. As mentioned, since 2008 in the USA government programs have developed polices to reduce the incidence of HAPI.¹⁰ Thus, there is a strong incentive in monitoring the PI incidence and prevalence. Furthermore, these epidemiological measures may vary across countries,^26,27 so we decided to focus the review on the USA including all settings and type of PIs. Because of the US focus, non-English articles were unlikely to be relevant: the language limit should not influence the sensitivity of the searches but only reduce the volume of records for screening. Since the rates of PIs may differ over time,²⁸ we limited the searches by year to decrease heterogeneity.

 

Table 1. PICOS eligibility criteria for the umbrella review.

 

Information sources and search strategy

The search strategy included three concepts combined as follows: pressure ulcer AND (prevalence OR incidence) AND (systematic reviews OR meta-analysis). No language filter was applied; only SRs published after 2010 were included. The searches were conducted in September 2022 and updated in September 2024 in the following databases: Excerpta Medica Database (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index for Nursing and Allied Health Literature (CINAHL) and Epistemonikos. The strategy was developed in EMBASE and subsequently adapted for the other databases. The searching strategy was integrated with snowballing approaches. Details of the searches, developed and conducted by an experienced information specialist, are presented as the Supplementary Material S1.

Selection process

Records were imported into EndNote 21²⁹ and de-duplicated using the ‘remove duplicates’ function. A two-step screening approach was used: two independent reviewers screened titles and abstracts, and then full texts through Rayyan.³⁰ Any disagreements about inclusion were resolved through discussion or by a third reviewer.

Data collection process

After screening, data were extracted into a predefined and piloted data extraction table (MS Office Excel). The data extraction was conducted by one reviewer and quality controlled by a second reviewer. Any discrepancies were discussed until consensus, or by a third reviewer.

Data items

Characteristics of the SRs, (publication date, geographic scope, aims, objectives, search years, inclusion and exclusion criteria, population and setting, data sources for PI definition, risk of bias method used, meta-analysis methods, overall results), population characteristics (mean age, gender percentage, distribution of severity PI), prevalence and incidence definitions and data with confidence intervals (for the USA or North America including USA and Canada, when possible), heterogeneity level³¹ I² and publication bias (Egger’s test results³²) were extracted and tabulated.

Quality of SRs and MAs

Two reviewers independently assessed the quality of SR and MA using the Assessment of Multiple Systematic Reviews version 2 (AMSTAR-2) instrument.³³ Any discrepancies in scoring were initially discussed between the two reviewers. If consensus could not be reached, a third reviewer was consulted to make a final decision. The AMSTAR-2 instrument consists of 16 items, with seven critical domains carrying greater weight in the overall rating. Based on responses to these items, SRs and MAs were classified into four quality categories: critically low, low, moderate, or high. To enhance consistency and ensure uniform interpretation of AMSTAR-2 criteria, reviewers adhered to predefined rules. For item 1, which assessed PICO alignment, emphasis was placed on whether the outcome definition was explicitly stated. For item 8, which evaluates the adequate description of primary studies, special attention was given to how the PI identification methods were reported in the primary studies.

Assessment of the study overlap

The overlaps between studies across the SRs included in the umbrella review was assessed through the corrected covered area (CCA) index. A score between 0 and 5% indicated a slight overlap, 6–10% moderate, 11–15% high, >15% very high overlap.³⁴

Assessment of feasibility of meta-MA

The feasibility assessment of meta-MA was based on the similarity among SRs of the aims; the similarity of the population, such as settings and patient characteristics, outcome (point prevalence, period prevalence, incidence rate and cumulative incidence) and outcome definitions; the quality of the SRs and MA; the study overlap; the availability of US data, including subgroup analysis per country.

Synthesis methods

If the feasibility assessment was positive, separate meta-MAs (random effect model) of point prevalence, cumulative incidence and incidence rate were planned. For period prevalence, data from similar time periods were considered. Subgroup and sensitivity analysis were considered to investigate heterogeneity (especially for different settings and populations) and a quantitative analysis of heterogeneity with I² and X² tests planned. Publication bias was to be assessed with an Egger’s test and funnel plots.

If the feasibility assessment did not support the meta-MA, then qualitative summaries of the data were planned through tabulation and descriptive analysis. Data of PI prevalence and incidence in USA obtained from high-quality SRs with MAs were synthesised narratively.

For the secondary objective, the quality of the SRs and MAs was assessed qualitatively. We considered the AMSTAR 2 score but also the qualitative elements emerged from the feasibility assessment and the AMSTAR scoring, such as the level of heterogeneity, the bias assessment, the reporting of the definitions of outcomes and of the PI identification.

Results

Study selection

The screening process is summarised in the PRISMA flow diagram (Figure 1). A total of 3568 records were identified up to September 2024; after screening of the titles and abstracts, 54 articles were left for full-text screening and 20 SRs with MA were considered eligible^{5,26,27,35-51}; reasons for study exclusions based on full text screening are reported in Supplementary Table S2.

Study characteristics

The characteristics of the eligible studies are reported in Table 2, including aims, overall results and AMSTAR II scores.

The majority of the 20 SRs with MA included in the umbrella review were recent, published after 2017, with only one study published in 2012.³⁹ All of them had a global reach, without geographical constraints. The reported outcomes were: point or period prevalence in five SRs^{26, 46-49}; incidence rate or cumulative incidence in six SRs^{27,37,39,43,45,50}; and nine SRs reported both prevalence and incidence measures.^{5,35,36,38,40-43,51}

 

Table 2. Characteristics of the eligible studies.

 

Quality of included SRs

The AMSTAR II scores were generally very poor with only two high,^44,51 one moderate³⁸ and two low quality overall scores,^41,46 the remaining 15 SRs had a critically low score (full scoring in Supplementary Table S3). Main issue was the lack of a list of reasons of article exclusions (16 out of 20) that is a critical domain. Other common issues were the justification of the included study designs (16 out of 20) and of the sources of funding (17 out of 20). Critical for this umbrella review was the unclear PICO definitions in the research question (15 out of 20) due mainly to the lack or unclear prevalence and incidence definitions and missing reporting methods to identify the PIs (that influenced the 14 Partial Yes in Item 8).

The majority of SRs (all except one⁴⁰) reported heterogeneity measures, usually the I², but only half of SRs evaluated or noted their effect on the final results.^{26,27,36,38,41,42,44,49-51} When reported, the heterogeneity was always very high (higher than 90%). The majority of SRs included tools for assessing the risk of publication bias (14 out of 20), usually the Egger’s test, and in six SRs publication bias was detected.^{27,42,45,47,50,51} The most common risk of bias tools used were Newcastle Ottawa Scale (NOS) in six SRs⁵² and Hoy et al’s tool in five SRs.⁵³

Meta-MA feasibility assessment

Aims 

The aims of the SR were similar (Table 2) with the main differences being in the population or setting of interest. None of the SRs limited their searches to specific geographical locations, all having a global approach.

Population and settings 

As reported in Table 3, the majority of SRs focused on a specific population or setting. Only three SRs investigated PIs in a broad population of hospitalised adult patients^35,37,44; whereas two SRs included only patients with spinal cord injuries^26,27;  two had cardiac patients^41,46; one palliative patients⁴⁰; two stroke patients^47,49; one fractured patients⁴³; one older adults⁵¹; five MDRPIs^{5,36,42,48,50}; four ICU patients^36,38,41,42; one ED patients⁴⁵; two surgical patients^39,46; six also included out-of-hospital facilities (such as long-term facilities, care homes and community).^{5,27,40,47,49,51}

Population characteristics 

The population characteristics were poorly reported (Table 3): Eight SRs reported the participants’ age^{5,27,37,40,43,44,46,51} and seven the PI severity.^{27,35,37,40,42-44}

 

Table 3. Detailed description of the eligible SRs.

 

Outcomes 

The outcomes ranged from point prevalence, period prevalence, cumulative incidence and incidence rate, but only five SRs properly defined the outcome.^{27,35,42,44,51} In the majority of the SRs the definition of the quantities ultimately reported in the results was unclear. In four SRs the prevalence and incidence data were both included in the same MA,^41,47,49,50 in seven SRs the authors did not specify whether they were referring to point prevalence or period prevalence, or which period.^{5,26,36,38,40,46,48} In four SRs it was not clear whether the outcome was incidence rate or cumulative incidence^37,39,43,45); for example the declared outcome was “incidence rate”, but the units of measurements used in the table were the units of the “cumulative rate” (percentages instead of patient-days.^{27,35,36,43,47,50} Only one SR reported the incidence rate correctly in patient-days.⁴⁴

PI definition 

The methods to define or classify the PIs were specified in eight SRs^{26,35,38,41,43,44,50,51} and ranged from indirect measures, such as patient self-reporting, surveys, medical records and electronic databases, to direct methods, such as skin assessment or use of the National Pressure Injury Advisory Panel and European Pressure Ulcer Advisory Panel (NPIAP & EPUAP) classifications.

Study overlap

Of the 96 publications included across the 20 SRs, 73 were unique primary studies; thus, the study overlap can be considered low (CCA=1.7% that corresponds to “slight overlap”). The overlap matrix of primary study results across eligible systematic reviews is presented in the Supplementary Table S4.

Number of US studies

Sixteen SRs included two or more US studies (Table 3), of which six performed a subgroup analysis for the USA or North American countries, which included both USA and Canada.^{26,27,35,44,50,51}

Narrative synthesis of the study quality and of the PI prevalence and incidence in USA

This umbrella review synthesised evidence from 20 SRs with MA on PI prevalence and incidence, revealing that the overall quality of studies was poor, with 15 out of 20 rated as critically low according to AMSTAR II. Key issues included unclear PICO definitions, missing exclusion reasons, and inconsistent outcome reporting—particularly in differentiating between point and period prevalence, and well as cumulative incidence and incidence rate. Heterogeneity was consistently high (>90%), yet only half of the SRs addressed its impact. Of the six meta-MA with USA or North America subgroup analysis, only two were high-quality, but they focused on different settings and populations,^44,51 making quantitative data pooling through a MA inappropriate. Only one high-quality study focused on the general population,⁴⁴ but the most recent primary studies were published more than six years ago in 2018. In this SLR with MAs the reported PI point prevalence for North America (USA and Canada) was 13.6% (95%CI:11.8-13.9%) and the incidence rate 3.0 per 10,000 patient-days (95%CI:0.8-6.4), whereas the point-prevalence globally was 12.8% (95% CI 11.8-13.9%), and incidence rate was 5.4 per 10,000 patient-days (95% CI 3.4-7.8).

The other high quality SLR with MAs was in older than 60-year-old residents of nursing homes.⁵⁴ The authors reported a PI point prevalence for North America (USA and Canada) of 13.3% (95%, CI:10.3–16.7%), whereas the overall point prevalence globally was 11.6% (95%, CI:9.6–13.7%) in the same population. The latest primary study included in this MA was published more than three years ago, in May 2022.

Discussion

A meta-MA of US studies for obtaining prevalence and incidence of PIs was not feasible because of the limited similarity across the SLRs, the low quality of the SRs with MAs and a lack of US studies or relevant country subgroup analysis. The narrative synthesis of the prevalence of the two high quality studies showed high point-prevalence (more than 13%) in USA, but these estimates are probably out of date, because they were obtained from primary studies published more than six years ago in hospitalisked patients⁴⁴ and more than three years ago in nursing homes.⁵¹

Lack of similarity across SRs: population and outcomes

The majority of the studies investigated only specific sub-populations, settings or were focused on MDRPIs. The other major issue related to the PICO was a lack of clarity in reporting (or the absence of) the definition of the outcomes of interest (such as incidence and prevalence). This issue was identified also in the past (2009) and a consensus paper was published⁵⁵ to support authors in the use of definitions for PIs, but unfortunately the effect of its dissemination seems negligible considering the results of the current umbrella review including only articles published after 2010. It is important to specify that incidence rate, cumulative incidence, point and period prevalence are not interchangeable, but represent different quantities that can and should be used in diverse contexts.^12,56,57 For example, incidence rate depends on observation time and might be more appropriate for studies that require an understanding of the rate at which new cases occur over a period, such as evaluating the effectiveness of new interventions or risk assessment tools. Cumulative incidence measures the proportion of individuals who develop a condition over a specified period and is a useful outcome for longitudinal studies assessing the overall risk within a population.^55,56

Point prevalence and period prevalence serve different purposes based on the timeframe they capture.^12,55 Point prevalence, which measures the proportion of individuals with a condition at a single point in time, is ideal, for example, for health economic models that require a snapshot of the current burden of disease to inform resource allocation and budgeting. Period prevalence, on the other hand, captures the proportion of individuals with a condition over a specified period and is useful, for example, for surveillance studies and audits aimed at evaluating the effectiveness of newly implemented pathways or protocols over time.^12,55,57

Lack of similarity across SRs: the PI definition

The PI identification or classification methods in the primary studies were often unclear in the included SRs. This can constitute a substantial source of inhomogeneity because the disease definition influences the measurements of prevalence and incidence.^55,58 Indeed, it was shown that prevalence and incidence seemed underestimated when PIs were retrospectively identified in the medical records, or with other indirect methods, compared to prospectively identified through skin assessment.^55,59,60 This made the reporting unreliable and unclear, and pooling the data quantitatively unfeasible.

The quality of the SRs with MAs

An aim of the review was to evaluate the quality of SRs with MAs on PI prevalence or incidence. Although this was also part of the feasibility assessment for the US meta-MAs, it was considered important enough, with implications broader than the US context, to stand as its own objective. The SRs in the umbrella review were generally considered of low quality, similar to what was previously reported for other prevalence and incidence SRs across different clinical areas.⁶¹ Only the quality of three SRs was not judged low or critically low according to the AMSTAR 2 instrument. Recently, SRs assessed with the AMSTAR 2 were found to reach very low scores,⁶² even for SRs published in high impact journals.⁶³ The reasons for the low scores were often very similar with a large number of studies not including conflict of interest lists and reasons of article exclusion.⁶³ Both are critical for increasing transparency, ensuring methodological rigor, and maintaining trust in the synthesis of evidence. The absence of these elements can undermine the validity and reliability of the SR conclusions, diminishing their impact on decision-making and future research.

It has been claimed that AMSTAR 2 was developed for SR of randomised controlled trials (RCTs), thus some of the items are not applicable for non-interventional SRs.⁶⁴ We found this potentially true, especially for item 3 (justification of study designs included in the SR): the exclusion of RCTs was often not justified, but it could be claimed that a justification was not needed considering the guidelines for prevalence SRs.⁶⁵ We decided to include the issues related to the outcome definition in the first item of the AMSTAR 2 (the alignment between the research question and inclusion criteria with the PICO). This item was found to be problematic for the assessment of non-interventional SRs.⁶⁴ We believe that the clear and transparent definition of the population and of the outcome are essential characteristics in a prevalence SR, so we found this item highly relevant to our assessment. Thus, even if there are criticisms concerning the AMSTAR 2 for assessing the quality of the non-interventional SRs, we found it a useful instrument, that allowed us to formally evaluate all the main issues that we noticed in our quality assessment. The low scoring of the included SRs was, indeed, aligned with our qualitative assessment of the reporting in the SRs of PI prevalence and incidence.

The low quality of the PI prevalence SRs is very concerning because it does not permit the drawing of general conclusions on the effective presence of the condition, not only in the USA, but also globally. From the two high quality SRs the situation appears worrying. The authors report global non-negligible values for point prevalence: just below 13% in hospitals,⁴⁴ and just below 12% in older patients in nursery homes.⁵¹

Impact on policy development

None of the published SRs with MAs can be relied upon for decision-making in the USA, as they were either of insufficient quality or outdated. A new primary SR with MA are required to analyse incidence rates and point-prevalence separately across distinct US healthcare settings (such as acute care facilities, long-term care facilities, nursing homes) and different types of PIs (MDRPIs and non-MDRPIs). This approach is crucial to prevent the inappropriate pooling of heterogenous data, ensuring more precise estimates. Accurate epidemiological assessments are essential for policy development enabling evidence-based planning and targeted interventions.

The findings of this umbrella review have significant implications for healthcare policy, particularly in the context of CMS regulations monitoring PI prevalence. Given that PIs are considered a “never event” in the USA, their occurrence directly impacts hospital reimbursement models. Our results highlight the need for standardised reporting and classification methods for PI prevalence and incidence to ensure accurate hospital performance assessments. Future policy decisions could leverage these findings to strengthen PI prevention strategies. For instance, CMS could mandate the use of standardised protocols for PI identification in hospitals to minimise inconsistencies in reporting and improve prevalence tracking. As it is likely that PI prevalence is influenced by care pathway changes,⁶⁶ reimbursement frameworks should integrate dynamic epidemiological data to optimise financial models and patient care strategies. Given the high prevalence of PIs in hospitalised adults and in care home residents reported in the two high-quality SRs with MAs, policymakers should prioritise the implementation of robust preventive frameworks and invest in further high-quality research to refine prevalence and incidence estimations. By improving the accuracy of PI data collection and integrating findings into reimbursement models, healthcare institutions can better allocate resources, reduce preventable patient harm, and optimise overall healthcare expenditures.

Limitations and strengths of the umbrella review

The main limitations of the current umbrella review are the temporal and geographical limits in the PICO. Whereas this approach could limit generalisability, it also increased homogeneity and interpretability of the review results, especially considering the possibility in our plans of a meta-MA. Indeed, it was shown that the variability of the prevalence and incidence of PI was very high.³ We showed this too with the high I² observed in all the SRs included in the umbrella review. The country was one of the factors influencing the estimations,^3,67 thus focusing on the country of interest was important, even if a limitation. Indeed, when developing a health economic model, for example, for a HTA submission in a specific country, epidemiological values related to that country should be used to reduce the uncertainty of the results estimated, especially if the values are highly variable. Since SRs of epidemiological variables are often used in these contexts, we would recommend SR authors to include subgroup analysis for countries (if feasible) to facilitate the use of the estimates provided in practical contexts.

Unlike the geographical limit, the temporal limit is common in this type of SRs, as evident also in the SRs included in the umbrella review. Indeed, these epidemiological measures seemed influenced by time,^28,44 possibly because the managerial policies, local guidelines and, thus, the care pathways change, influencing the prevalence of the diseases.⁵⁸ This is always true, but especially for a sensitive condition such as PIs, considered a “never event”, index of hospital performance, directly influencing reimbursement in the USA.^10,68 Thus, including data obtained from a not recent MA is unlikely to increase the precision of the estimation, but it is likely, instead, to increase heterogeneity adding more noise than useful data for an accurate description of the current situation.

Conclusion

To the best of the authors’ knowledge, this was the first umbrella review evaluating the prevalence and incidence of PIs with a specific focus on US data, while also assessing the overall quality of the SRs.

Although a meta-MA that estimated an overall measurement for prevalence or incidence of PIs in the USA was considered not feasible, we could identify one high quality SR with MAs in the hospitalised adults,⁴⁴ and one in nursing homes residents.⁵¹ These SRs reported well-defined outcomes (point prevalence and incidence rate) and included North American studies analyzed in sub-group analyses. Two main concerns were still recognised: data came from not very recent studies and some studies were not from the USA but from Canada. Thus, we would recommend updating the SRs and rerunning the subgroup analysis only including US studies to obtain reliable point prevalence data to be used, for example, to populate a health economic evaluation for US HTA submissions.

Implication for clinical practice or further research

Implications for Clinical Practice

• The incidence of PIs in the USA and globally is high considering the data reported in the only two high-quality studies in hospitalised patients and in nursing homes.
• Consistent methods for tracking PI rates in hospitals, as well as in clinical studies, could facilitate planning preventive strategies and assessing their effect in terms of patient health and costs.
• The inconsistent and often unclear classification methods for PIs in the included SRs suggest a need for standardised protocols for PI identification and documentation, in acute settings and long-term care facilities, but also in clinical studies.

Further research

• SRs and MAs of PIs prevalence and incidence were very low quality; there is a need for more robust prevalence and incidence assessments both in primary research and in secondary research, using standard definitions of outcomes and prospective assessment of PIs.
• Alignment to appropriate methodologies for delivery and reporting SRs would facilitate data pooling through a review of reviews and meta-MA; in particular, robust evaluation of similarities of studies, of population, settings and outcomes would be essential.

Supporting information

Supplementary Material S1. Search strategies.

Supplementary Table S2. The list of excluded studies with the reason of exclusion.

Supplementary Table S3. AMSTAR 2 Quality assessment of eligible systematic reviews.

Supplementary Table S4. The overlap matrix of primary study results across eligible systematic reviews.

Conflict of interest

Anna Serafin, and Vladica Velickovic are employed by Paul Hartmann AG (part of HARTMANN GROUP). Sara Graziadio is an independent consultant contracted by Paul Hartmann AG (part of HARTMANN GROUP). The University of Birmingham received the grant from Paul Hartmann AG to develop the search codes for databases and conducted the database search. The remaining authors have no conflicts of interest to declare.

Funding

Source of funding: This review was not supported by any funding. Jacqueline Dinnes was supported by the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC).”

Author(s)

Sara Graziadio^1,2, Anna Serafin¹ Niuosha Sanaeifar¹, Anitha Pitchika¹, Jacqueline Dinnes^3,4, Alice Sitch^3,4, April Coombe⁴, Heather Lueck⁵, Vladica Veličković*^1,6
1Evidence Generation Department, HARTMANN GROUP, Heidenheim, Germany
²Graziadio Consulting, Viterbo, Italy
³Biostatistics, Evidence Synthesis, Test Evaluation And Prediction Modelling (BESTEAM), Institute of Applied Health Research, University of Birmingham, UK
⁴NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK
⁵Mercy Hospital Springfield, MO, USA
⁶Institute of Public Health, Medical Decision Making and HTA, UMIT, Austria

*Corresponding author email vladica.velickovic@hartmann.info

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Supplementary material

S1. Search strategies

Search narrative for pressure ulcers prevalence and incidence review (Review 1) September 2022

A master search strategy and sources to be searched was agreed. The initial strategy was developed in EMBASE and subsequently adapted for MEDLINE, EPISTIMONIKOS and CINAHL.

The strategy searched for Pressure Ulcer AND Prevalence/Incidence AND Systematic reviews/Meta-analysis published since 2010. No language filter was applied.

Results were imported into EndNote and an auto deduplication was run. Established methodological filters have been used in EMBASE and MEDLINE combining the appropriate McMasters best balance reviews filters¹ with the CADTH SR filter.² Adaptations of these two filters were used in CINAHL and for EPISTIMONIKOS the inbuilt systematic review filter was used.

 

1. Search strategies for EMBASE in Ovid Syntax, In Health Information Research Unit Hedges project.Ontario:HIRU;2022: Health Information Research Unit - HIRU ~ Search Strategies for EMBASE in Ovid Syntax (mcmaster.ca)  Accessed 2022-09-29 and
Search strategies for MEDLINE in Ovid Syntax, In Health Information Research Unit Hedges project.Ontario:HIRU;2022: Health Information Research Unit - HIRU ~ Search Strategies for MEDLINE in Ovid Syntax and the PubMed translation (mcmaster.ca)  Accessed 2022-09-29.

2. SR / MA / HTA / ITC - MEDLINE, Embase, PsycInfo. In: CADTH Search Filters Database. Ottawa: CADTH; 2022: https://searchfilters.cadth.ca/link/33. Accessed 2022-09-29.

 

Summary table of searches before and after deduplication:

 

Sources searched

Database: Embase <1974 to 2022 September 26>

Date run: 27 September 2022

Search Strategy:

1 (decubit* or bedsore* or bed-sore* or pressure-ulcer* or pressure-wound*).tw. (23693)

2 ((pressure* or bed or bedbound or bed-bound or bedridden or bed-ridden or deep tissue* or deep-tissue) adj3 (wound* or ulcer* or sore* or injur* or lesion*)).tw. (28068)

3 exp decubitus/ (24050)

4 1 or 2 or 3 (44224)

5 ((supine or immobil*) adj3 (heal or healing or heals or healed or dress*)).tw. (271)

6 ((supine or immobil*) adj3 (wound* or ulcer* or sore* or injur* or lesion*)).tw. (1158)

7 ((pressure or bedbound or bedridden or bed-bound or bed-ridden or deep tissue or deep-tissue) adj3 (heal or healing or heals or healed or dress*)).tw. (2416)

8 5 or 6 or 7 (3800)

9 exp epidemiology/ (4151169)

10 exp prevalence/ (913181)

11 exp incidence/ (616222)

12 (prevalen* or epidemiolog* or incidence*).tw. (2791265)

13 ep.fs. (1133082)

14 9 or 10 or 11 or 12 or 13 (5786348)

15 4 and 14 (12031)

16 4 or 8 (46461)

17 14 and 16 (12463)

18 (systematic review or meta-analysis).pt. (0)

19 review.pt. (2954013)

20 search:.tw. (743381)

21 meta-analys:.mp. (398354)

22 meta-analysis/ or systematic review/ or systematic reviews as topic/ or meta-analysis as topic/ or “meta analysis (topic)”/ or “systematic review (topic)”/ or exp technology assessment, biomedical/ or network meta-analysis/ (559858)

23 ((systematic* adj3 (review* or overview*)) or (methodologic* adj3 (review* or overview*))).ti,ab,kf. (350047)

24 ((quantitative adj3 (review* or overview* or synthes*)) or (research adj3 (integrati* or overview*))).ti,ab,kf. (16762)

25 ((integrative adj3 (review* or overview*)) or (collaborative adj3 (review* or overview*)) or (pool* adj3 analy*)).ti,ab,kf. (50712)

26 (data synthes* or data extraction* or data abstraction*).ti,ab,kf. (45046)

27 (handsearch* or hand search*).ti,ab,kf. (13015)

28 (mantel haenszel or peto or der simonian or dersimonian or fixed effect* or latin square*).ti,ab,kf. (43888)

29 (met analy* or metanaly* or technology assessment* or HTA or HTAs or technology overview* or technology appraisal*).ti,ab,kf. (18523)

30 (meta regression* or metaregression*).ti,ab,kf. (16152)

31 (meta-analy* or metaanaly* or systematic review* or biomedical technology assessment* or bio-medical technology assessment*).mp,hw. (667911)

32 (medline or cochrane or pubmed or medlars or embase or cinahl).ti,ab,hw. (403320)

33 (cochrane or (health adj2 technology assessment) or evidence report).jw. (29355)

34 (comparative adj3 (efficacy or effectiveness)).ti,ab,kf. (24131)

35 (outcomes research or relative effectiveness).ti,ab,kf. (15453)

36 ((indirect or indirect treatment or mixed-treatment or bayesian) adj3 comparison*).ti,ab,kf. (7000)

37 (multi* adj3 treatment adj3 comparison*).ti,ab,kf. (406)

38 (mixed adj3 treatment adj3 (meta-analy* or metaanaly*)).ti,ab,kf. (257)

39 umbrella review*.ti,ab,kf. (1201)

40 (multi* adj2 paramet* adj2 evidence adj2 synthesis).ti,ab,kf. (27)

41 (multiparamet* adj2 evidence adj2 synthesis).ti,ab,kf. (18)

42 (multi-paramet* adj2 evidence adj2 synthesis).ti,ab,kf. (22)

43 or/19-42 (3841668)

44 15 and 43 (1888)

45 or/22-42 (902978)

46 17 and 43 (1954)

47 limit 46 to yr=”2010 -Current” (1308)

Database: Ovid MEDLINE(R) ALL <1946 to September 27, 2022>

Date run: 27 September 2022

Search Strategy:

1 (decubit* or bedsore* or bed-sore* or pressure-ulcer* or pressure-wound*).tw. (17654)

2 ((pressure* or bed or bedbound or bed-bound or bedridden or bed-ridden or deep tissue* or deep-tissue) adj3 (wound* or ulcer* or sore* or injur* or lesion*)).tw. (21644)

3 exp pressure ulcer/ or pressure/ae (15120)

4 1 or 2 or 3 (32619)

5 ((supine or immobil*) adj3 (heal or healing or heals or healed or dress*)).tw. (216)

6 ((supine or immobil*) adj3 (wound* or ulcer* or sore* or injur* or lesion*)).tw. (862)

7 ((pressure or bedbound or bedridden or bed-bound or bed-ridden or deep tissue or deep-tissue) adj3 (heal or healing or heals or healed or dress*)).tw. (1831)

8 5 or 6 or 7 (2874)

9 exp epidemiology/ (28219)

10 exp prevalence/ (335103)

11 exp incidence/ (295819)

12 (prevalen* or epidemiolog* or incidence*).tw. (2009689)

13 ep.fs. (2020472)

14 9 or 10 or 11 or 12 or 13 (3274852)

15 4 and 14 (6126)

16 4 or 8 (34325)

17 14 and 16 (6344)

18 (systematic review or meta-analysis).pt. (286718)

19 meta analysis.mp,pt. (255651)

20 review.pt. (3051852)

21search:.tw. (594395)

22 meta-analysis/ or systematic review/ or systematic reviews as topic/ or meta-analysis as topic/ or “meta analysis (topic)”/ or “systematic review (topic)”/ or exp technology assessment, biomedical/ or network meta-analysis/ (323398)

23 ((systematic* adj3 (review* or overview*)) or (methodologic* adj3 (review* or overview*))).ti,ab,kf. (286564)

24 ((quantitative adj3 (review* or overview* or synthes*)) or (research adj3 (integrati* or overview*))).ti,ab,kf. (14383)

25 ((integrative adj3 (review* or overview*)) or (collaborative adj3 (review* or overview*)) or (pool* adj3 analy*)).ti,ab,kf. (35963)

26 (data synthes* or data extraction* or data abstraction*).ti,ab,kf. (37007)

27 (handsearch* or hand search*).ti,ab,kf. (10718)

28 (mantel haenszel or peto or der simonian or dersimonian or fixed effect* or latin square*).ti,ab,kf. (33275)

29 (met analy* or metanaly* or technology assessment* or HTA or HTAs or technology overview* or technology appraisal*).ti,ab,kf. (11493)

30 (meta regression* or metaregression*).ti,ab,kf. (13167)

31 (meta-analy* or metaanaly* or systematic review* or biomedical technology assessment* or bio-medical technology assessment*).mp,hw. (426698)

32 (medline or cochrane or pubmed or medlars or embase or cinahl).ti,ab,hw. (310593)

33 (cochrane or (health adj2 technology assessment) or evidence report).jw. (21027)

34 (comparative adj3 (efficacy or effectiveness)).ti,ab,kf. (16551)

35 (outcomes research or relative effectiveness).ti,ab,kf. (10788)

36 ((indirect or indirect treatment or mixed-treatment or bayesian) adj3 comparison*).ti,ab,kf. (4083)

37 (multi* adj3 treatment adj3 comparison*).ti,ab,kf. (284)

38 (mixed adj3 treatment adj3 (meta-analy* or metaanaly*)).ti,ab,kf. (177)

39 umbrella review*.ti,ab,kf. (1147)

40 (multi* adj2 paramet* adj2 evidence adj2 synthesis).ti,ab,kf. (13)

41 (multiparamet* adj2 evidence adj2 synthesis).ti,ab,kf. (17)

42 (multi-paramet* adj2 evidence adj2 synthesis).ti,ab,kf. (11)

43 or/19-42 (3634610)

44 15 and 43 (1041)

45 or/22-42 (628894)

46 17 and 43 (1089)

47 limit 46 to yr=”2010 -Current” (663)

Epistemonikos

Date run: 27 September 2022

The Epistemonikos interface does not support all the search functionality available in OVID (for example adjacency operators are not supported). The Information Specialist ran several separate shorter searches to accommodate for the limitations of the interface. In total nine separate searches were run and imported into Endnote where any duplicate records were removed.

Searches 1-9

(title:(decubit* OR bedsore* OR bed-sore* OR pressure-ulcer* OR pressure-wound*) OR abstract:(decubit* OR bedsore* OR bed-sore* OR pressure-ulcer* OR pressure-wound*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*))

Limit by year; 2010 onwards only and Limit by publication type: systematic review

Results: 27

(title:(pressure wound* OR pressure ulcer*) OR abstract:(pressure wound* OR pressure ulcer*)) OR (title:(pressure sore* OR pressure lesion*) OR abstract:(pressure sore* OR pressure lesion*)) OR (title:(pressure injur*) OR abstract:(pressure injur*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*))

Limit by year; 2010 onwards only and Limit by publication type: systematic review

Results: 209

(title:(deep-tissue wound* OR deep-tissue ulcer*) OR abstract:(deep-tissue wound* OR deep-tissue ulcer*)) OR (title:(deep-tissue sore* OR deep-tissue lesion*) OR abstract:(deep-tissue sore* OR deep-tissue lesion*)) OR (title:(deep-tissue injur*) OR abstract:(deep-tissue injur*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*))

Limit by year; 2010 onwards only and Limit by publication type: systematic review

Results: 0

(title:(deep tissue wound* OR deep tissue ulcer*) OR abstract:(deep tissue wound* OR deep tissue ulcer*)) OR (title:(deep tissue sore* OR deep tissue lesion*) OR abstract:(deep tissue sore* OR deep tissue lesion*)) OR (title:(deep tissue injur*) OR abstract:(deep tissue injur*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*))

Limit by year; 2010 onwards only and Limit by publication type: systematic review

Results: 7

(title:(bed wound* OR bed ulcer* ) OR abstract:(bed wound* OR bed ulcer*)) OR (title:(bed sore* OR bed lesion*) OR abstract:(bed sore* OR bed lesion*)) OR (title:(bed injur*) OR abstract:(bed injur*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*))

Limit by year; 2010 onwards only and Limit by publication type: systematic review

Results: 20

(title:(bed bound OR bed-bound) OR abstract:(bed bound* OR bed-bound)) OR (title:(bedridden) OR abstract:(bedridden)) OR (title:(bed-ridden) OR abstract:(bed-ridden)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*))

Limit by year; 2010 onwards only and Limit by publication type: systematic review

Results: 0

(title:(supine OR immobil*) OR abstract:(supine OR immobil*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*)) AND (title:(heal OR healing OR heals OR healed OR dress*) OR abstract:(heal OR healing OR heals OR healed OR dress*))

Limit by year; 2010 onwards only and Limit by publication type: systematic review

Results: 7

(title:(supine OR immobil*) OR abstract:(supine OR immobil*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*)) AND (title:(wound* OR ulcer* OR sore* OR injur* OR lesion*) OR abstract:(wound* OR ulcer* OR sore* OR injur* OR lesion*))

Limit by year; 2010 onwards only and Limit by publication type: systematic review

Results: 42

(title:(pressure OR bedbound OR bedridden OR bed-bound OR bed-ridden OR deep tissue OR deep-tissue) OR abstract:(pressure OR bedbound OR bedridden OR bed-bound OR bed-ridden OR deep tissue OR deep-tissue)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*)) AND (title:(heal OR healing OR heals OR healed OR dress*) OR abstract:(heal OR healing OR heals OR healed OR dress*))

Results 167

Cinahl search

Date run: 28 September 2022

S1 ( ((TI decubit* OR AB decubit*) OR (TI bedsore* OR AB bedsore*) OR (TI bed-sore* OR AB bed-sore*) OR (TI pressure-ulcer* OR AB pressure-ulcer*) OR (TI pressure-wound* OR AB pressure-wound*)) ) OR ( (((TI pressure* OR AB pressure*) OR (TI bed OR AB bed) OR (TI bedbound OR AB bedbound) OR (TI bed-bound OR AB bed-bound) OR (TI bedridden OR AB bedridden) OR (TI bed-ridden OR AB bed-ridden) OR (TI “deep tissue*” OR AB “deep tissue*”) OR (TI deep-tissue OR AB deep-tissue)) N3 ((TI wound* OR AB wound*) OR (TI ulcer* OR AB ulcer*) OR (TI sore* OR AB sore*) OR (TI injur* OR AB injur*) OR (TI lesion* OR AB lesion*))) ) OR ( (MH “pressure ulcer”+) OR (MH pressure) ) (28,012)

S2 ( ((TI heal OR AB heal) OR (TI healing OR AB healing) OR (TI heals OR AB heals) OR (TI healed OR AB healed) OR (TI dress* OR AB dress*))) ) OR ( (((TI supine OR AB supine) OR (TI immobil* OR AB immobil*)) N3 ((TI wound* OR AB wound*) OR (TI ulcer* OR AB ulcer*) OR (TI sore* OR AB sore*) OR (TI injur* OR AB injur*) OR (TI lesion* OR AB lesion*))) ) OR ( (((TI pressure OR AB pressure) OR (TI bedbound OR AB bedbound) OR (TI bedridden OR AB bedridden) OR (TI bed-bound OR AB bed-bound) OR (TI bed-ridden OR AB bed-ridden) OR (TI “deep tissue” OR AB “deep tissue”) OR (TI deep-tissue OR AB deep-tissue)) N3 ((TI heal OR AB heal) OR (TI healing OR AB healing) OR (TI heals OR AB heals) OR (TI healed OR AB healed) OR (TI dress* OR AB dress*))) ) (70,879)

S3 S1 OR S2 (94,532)

S4 ( ((TI prevalen* OR AB prevalen*) OR (TI epidemiolog* OR AB epidemiolog*) OR (TI incidence* OR AB incidence*)) ) OR (MH epidemiology+) OR (MH prevalence+) OR (MH incidence+) (1,102,939)

S5 S3 AND S4 (11,568)

S6 ( (PT “systematic review” OR PT meta-analysis) ) OR ( (MH meta-analysis) OR (MH “systematic review”) OR (MH “systematic reviews as topic”) OR (MH “meta-analysis as topic”) OR (MH “meta analysis (topic)”) OR (MH “systematic review (topic)”) OR (MH “technology assessment, biomedical”+) OR (MH “network meta-analysis”) ) OR ( (((TI systematic* OR AB systematic* OR SU systematic*) N3 ((TI review* OR AB review* OR SU review*) OR (TI overview* OR AB overview* OR SU overview*))) OR ((TI methodologic* OR AB methodologic* OR SU methodologic*) N3 ((TI review* OR AB review* OR SU review*) OR (TI overview* OR AB overview* OR SU overview*)))) ) OR ( (((TI quantitative OR AB quantitative OR SU quantitative) N3 ((TI review* OR AB review* OR SU review*) OR (TI overview* OR AB overview* OR SU overview*) OR (TI synthes* OR AB synthes* OR SU synthes*))) OR ((TI research OR AB research OR SU research) N3 ((TI integrati* OR AB integrati* OR SU integrati*) OR (TI overview* OR AB overview* OR SU overview*)))) ) OR ( (((TI integrative OR AB integrative OR SU integrative) N3 ((TI review* OR AB review* OR SU review*) OR (TI overview* OR AB overview* OR SU overview*))) OR ((TI collaborative OR AB collaborative OR SU collaborative) N3 ((TI review* OR AB review* OR SU review*) OR (TI overview* OR AB overview* OR SU overview*))) OR ((TI pool* OR AB pool* OR SU pool*) N3 (TI analy* OR AB analy* OR SU analy*))) ) OR ( ((TI “data synthes*” OR AB “data synthes*” OR SU “data synthes*”) OR (TI “data extraction*” OR AB “data extraction*” OR SU “data extraction*”) OR (TI “data abstraction*” OR AB “data abstraction*” OR SU “data abstraction*”)) ) OR ( ((TI handsearch* OR AB handsearch* OR SU handsearch*) OR (TI “hand search*” OR AB “hand search*” OR SU “hand search*”)) ) OR ( ((TI “mantel haenszel” OR AB “mantel haenszel” OR SU “mantel haenszel”) OR (TI peto OR AB peto OR SU peto) OR (TI “der simonian” OR AB “der simonian” OR SU “der simonian”) OR (TI dersimonian OR AB dersimonian OR SU dersimonian) OR (TI “fixed effect*” OR AB “fixed effect*” OR SU “fixed effect*”) OR (TI “latin square*” OR AB “latin square*” OR SU “latin square*”)) ) OR ( ((TI “met analy*” OR AB “met analy*” OR SU “met analy*”) OR (TI metanaly* OR AB metanaly* OR SU metanaly*) OR (TI “technology assessment*” OR AB “technology assessment*” OR SU “technology assessment*”) OR (TI HTA OR AB HTA OR SU HTA) OR (TI HTAs OR AB HTAs OR SU HTAs) OR (TI “technology overview*” OR AB “technology overview*” OR SU “technology overview*”) OR (TI “technology appraisal*” OR AB “technology appraisal*” OR SU “technology appraisal*”)) ) OR ( ((TI “meta regression*” OR AB “meta regression*” OR SU “meta regression*”) OR (TI metaregression* OR AB metaregression* OR SU metaregression*)) ) OR ( (meta-analy* OR metaanaly* OR “systematic review*” OR “biomedical technology assessment*” OR “bio-medical technology assessment*”) ,hw. ) OR ( ((TI medline OR AB medline) OR (TI cochrane OR AB cochrane) OR (TI pubmed OR AB pubmed) OR (TI medlars OR AB medlars) OR (TI embase OR AB embase) OR (TI cinahl OR AB cinahl)) ,hw. ) (228,793)

S7 ( (cochrane OR ( health N2 “technology assessment”) OR “evidence report”) .jw. ) OR ( ((TI comparative OR AB comparative OR SU comparative) N3 ((TI efficacy OR AB efficacy OR SU efficacy) OR (TI effectiveness OR AB effectiveness OR SU effectiveness))) ) OR ( ((TI “outcomes research” OR AB “outcomes research” OR SU “outcomes research”) OR (TI “relative effectiveness” OR AB “relative effectiveness” OR SU “relative effectiveness”)) ) OR ( (((TI indirect OR AB indirect OR SU indirect) OR (TI “indirect treatment” OR AB “indirect treatment” OR SU “indirect treatment”) OR (TI mixed-treatment OR AB mixed-treatment OR SU mixed-treatment) OR (TI bayesian OR AB bayesian OR SU bayesian)) N3 (TI comparison* OR AB comparison* OR SU comparison*)) ) OR ( ((TI multi* OR AB multi* OR SU multi*) N3 (TI treatment OR AB treatment OR SU treatment) N3 (TI comparison* OR AB comparison* OR SU comparison*)) ) OR ( (TI “umbrella review*” OR AB “umbrella review*” OR SU “umbrella review*”) ) OR ( ((TI multi* OR AB multi* OR SU multi*) N2 (TI paramet* OR AB paramet* OR SU paramet*) N2 (TI evidence OR AB evidence OR SU evidence) N2 (TI synthesis OR AB synthesis OR SU synthesis)) ) OR ( ((TI multiparamet* OR AB multiparamet* OR SU multiparamet*) N2 (TI evidence OR AB evidence OR SU evidence) N2 (TI synthesis OR AB synthesis OR SU synthesis)) ) OR ( ((TI multi-paramet* OR AB multi-paramet* OR SU multi-paramet*) N2 (TI evidence OR AB evidence OR SU evidence) N2 (TI synthesis OR AB synthesis OR SU synthesis)) ) (18,780)

S8 ((TI search: OR AB search:)) (119,853)

S9 PT review (350,435)

S10 S6 OR S7 OR S8 OR S9 (629,922)

S11 S5 AND S10 (1,648)

S12 S5 AND S10 (1,170)

September 2024 update searches

This is an update to the September 2022 search strategy. The strategy searched for Pressure Ulcer AND Prevalence/Incidence AND Systematic reviews/Meta-analysis published since the original review was undertake. No language filter was applied.

Results were imported into EndNote and an auto deduplication was run.

Summary table of searches before and after deduplication:

 

Sources searched

Database: Embase <1974 to 2024 September 24> (OVID platform)

Date run: 26 September 2024

1 (decubit* or bedsore* or bed-sore* or pressure-ulcer* or pressure-wound*).tw. 26320

2 ((pressure* or bed or bedbound or bed-bound or bedridden or bed-ridden or deep tissue* or deep-tissue) adj3 (wound* or ulcer* or sore* or injur* or lesion*)).tw. 31755

3 exp decubitus/ 27096

4 1 or 2 or 3 49803

5 ((supine or immobil*) adj3 (heal or healing or heals or healed or dress*)).tw. 292

6 ((supine or immobil*) adj3 (wound* or ulcer* or sore* or injur* or lesion*)).tw. 1262

7 ((pressure or bedbound or bedridden or bed-bound or bed-ridden or deep tissue or deep-tissue) adj3 (heal or healing or heals or healed or dress*)).tw. 2699

8 5 or 6 or 7 4203

9 exp epidemiology/ 4859309

10 exp prevalence/ 1086436

11 exp incidence/ 743970

12 (prevalen* or epidemiolog* or incidence*).tw. 3224889

13 ep.fs. 1216449

14 9 or 10 or 11 or 12 or 13 6691790

15 4 and 14 13976

16 4 or 8 52237

17 14 and 16 14453

18 (systematic review or meta-analysis).pt. 0

19 review.pt. 3278749

20 search:.tw. 898202

21 meta-analys:.mp. 500448

22 meta-analysis/ or systematic review/ or systematic reviews as topic/ or meta-analysis as topic/ or “meta analysis (topic)”/ or “systematic review (topic)”/ or exp technology assessment, biomedical/ or network meta-analysis/ 705019

23 ((systematic* adj3 (review* or overview*)) or (methodologic* adj3 (review* or overview*))).ti,ab,kf. 458712

24 ((quantitative adj3 (review* or overview* or synthes*)) or (research adj3 (integrati* or overview*))).ti,ab,kf. 20798

25 ((integrative adj3 (review* or overview*)) or (collaborative adj3 (review* or overview*)) or (pool* adj3 analy*)).ti,ab,kf. 61444

26 (data synthes* or data extraction* or data abstraction*).ti,ab,kf. 57079

27 (handsearch* or hand search*).ti,ab,kf. 14313

28 (mantel haenszel or peto or der simonian or dersimonian or fixed effect* or latin square*).ti,ab,kf. 51990

29 (met analy* or metanaly* or technology assessment* or HTA or HTAs or technology overview* or technology appraisal*).ti,ab,kf. 22664

30 (meta regression* or metaregression*).ti,ab,kf. 20774

31 (meta-analy* or metaanaly* or systematic review* or biomedical technology assessment* or bio-medical technology assessment*).mp,hw. 834234

32 (medline or cochrane or pubmed or medlars or embase or cinahl).ti,ab,hw. 513081

33 (cochrane or (health adj2 technology assessment) or evidence report).jw. 32388

34 (comparative adj3 (efficacy or effectiveness)).ti,ab,kf. 28858

35 (outcomes research or relative effectiveness).ti,ab,kf. 17249

36 ((indirect or indirect treatment or mixed-treatment or bayesian) adj3 comparison*).ti,ab,kf. 8328

37 (multi* adj3 treatment adj3 comparison*).ti,ab,kf. 455

38 (mixed adj3 treatment adj3 (meta-analy* or metaanaly*)).ti,ab,kf. 264

39 umbrella review*.ti,ab,kf. 2373

40 multi* adj2 paramet* adj2 evidence adj2 synthesis).ti,ab,kf. 36

41 (multiparamet* adj2 evidence adj2 synthesis).ti,ab,kf. 22

42 (multi-paramet* adj2 evidence adj2 synthesis).ti,ab,kf. 31

43 or/19-42 4345298

44 15 and 43 2218

45 or/22-42 1119327

46 17 and 43 2292

47 limit 46 to dc=20220101-20241231 486 

Database: Ovid MEDLINE(R) ALL <1946 to September 24, 2024>

Date run: 26 September 2024

Search Strategy:

1 (decubit* or bedsore* or bed-sore* or pressure-ulcer* or pressure-wound*).tw. 19498

2 ((pressure* or bed or bedbound or bed-bound or bedridden or bed-ridden or deep tissue* or deep-tissue) adj3 (wound* or ulcer* or sore* or injur* or lesion*)).tw. 24502

3 exp pressure ulcer/ or pressure/ae 16320

4 1 or 2 or 3 35981

5 ((supine or immobil*) adj3 (heal or healing or heals or healed or dress*)).tw. 235

6 ((supine or immobil*) adj3 (wound* or ulcer* or sore* or injur* or lesion*)).tw. 928

7 ((pressure or bedbound or bedridden or bed-bound or bed-ridden or deep tissue or deep-tissue) adj3 (heal or healing or heals or healed or dress*)).tw. 2027

8 5 or 6 or 7 3151

9 exp epidemiology/ 28856

10 exp prevalence/ 359113

11 exp incidence/ 311617

12 (prevalen* or epidemiolog* or incidence*).tw. 2294806

13 ep.fs. 2247607

14 9 or 10 or 11 or 12 or 13 3690402

15 4 and 14 7023

16 4 or 8 37822

17 14 and 16 7263

18 (systematic review or meta-analysis).pt. 362864

19 meta analysis.mp,pt. 319321

20 review.pt. 3388790

21 search:.tw. 722100

22 meta-analysis/ or systematic review/ or systematic reviews as topic/ or meta-analysis as topic/ or “meta analysis (topic)”/ or “systematic review (topic)”/ or exp technology assessment, biomedical/ or network meta-analysis/ 405415

23 ((systematic* adj3 (review* or overview*)) or (methodologic* adj3 (review* or overview*))).ti,ab,kf. 381951

24 ((quantitative adj3 (review* or overview* or synthes*)) or (research adj3 (integrati* or overview*))).ti,ab,kf. 18214

25 ((integrative adj3 (review* or overview*)) or (collaborative adj3 (review* or overview*)) or (pool* adj3 analy*)).ti,ab,kf. 43988

26 (data synthes* or data extraction* or data abstraction*).ti,ab,kf. 47322

27 (handsearch* or hand search*).ti,ab,kf. 11762

28 (mantel haenszel or peto or der simonian or dersimonian or fixed effect* or latin square*).ti,ab,kf. 39471

29 (met analy* or metanaly* or technology assessment* or HTA or HTAs or technology overview* or technology appraisal*).ti,ab,kf. 13433

30 (meta regression* or metaregression*).ti,ab,kf. 17148

31 (meta-analy* or metaanaly* or systematic review* or biomedical technology assessment* or bio-medical technology assessment*).mp,hw. 540343

32 (medline or cochrane or pubmed or medlars or embase or cinahl).ti,ab,hw. 398069

33 (cochrane or (health adj2 technology assessment) or evidence report).jw. 22093

34 (comparative adj3 (efficacy or effectiveness)).ti,ab,kf. 19704

35 (outcomes research or relative effectiveness).ti,ab,kf. 11951

36 ((indirect or indirect treatment or mixed-treatment or bayesian) adj3 comparison*).ti,ab,kf. 4762

37 (multi* adj3 treatment adj3 comparison*).ti,ab,kf. 316

38 (mixed adj3 treatment adj3 (meta-analy* or metaanaly*)).ti,ab,kf. 182

39 umbrella review*.ti,ab,kf. 2257

40 (multi* adj2 paramet* adj2 evidence adj2 synthesis).ti,ab,kf. 15

41 (multiparamet* adj2 evidence adj2 synthesis).ti,ab,kf. 19

42 (multi-paramet* adj2 evidence adj2 synthesis).ti,ab,kf. 13

43 or/19-42 4080587

44 15 and 43 1234

45 or/22-42 782165

46 17 and 43 1287

47 (2022* or 2023* or 2024* or 2025*).dt,ez,da. 4748921

48 46 and 47 285

 

Epistemonikos

Date run: 26 September 2024

The Epistemonikos interface does not support all the search functionality available in OVID (for example adjacency operators are not supported) so simpler searches were required. The Information Specialist ran several separate shorter searches to accommodate for the limitations of the interface. In total nine separate overlapping searches were run and imported into Endnote where any duplicate records were removed.

Searches 1-9

1. (title:(decubit* OR bedsore* OR bed-sore* OR pressure-ulcer* OR pressure-wound*) OR abstract:(decubit* OR bedsore* OR bed-sore* OR pressure-ulcer* OR pressure-wound*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*))

Limit by publication year 2022,2023,2024 and added to database 01/09/22-29/09/24 and systematic reviews

Results: 7

2. (title:(pressure wound* OR pressure ulcer*) OR abstract:(pressure wound* OR pressure ulcer*)) OR (title:(pressure sore* OR pressure lesion*) OR abstract:(pressure sore* OR pressure lesion*)) OR (title:(pressure injur*) OR abstract:(pressure injur*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*))

Limit by publication year 2022,2023,2024 and added to database 01/09/22-29/09/24 and systematic reviews

Results: 88

3.(title:(deep-tissue wound* OR deep-tissue ulcer*) OR abstract:(deep-tissue wound* OR deep-tissue ulcer*)) OR (title:(deep-tissue sore* OR deep-tissue lesion*) OR abstract:(deep-tissue sore* OR deep-tissue lesion*)) OR (title:(deep-tissue injur*) OR abstract:(deep-tissue injur*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*))

Limit by publication year 2022,2023,2024 and added to database 01/09/22-29/09/24 and systematic reviews

Results: 0

4. (title:(deep tissue wound* OR deep tissue ulcer*) OR abstract:(deep tissue wound* OR deep tissue ulcer*)) OR (title:(deep tissue sore* OR deep tissue lesion*) OR abstract:(deep tissue sore* OR deep tissue lesion*)) OR (title:(deep tissue injur*) OR abstract:(deep tissue injur*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*))

Limit by publication year 2022,2023,2024 and added to database 01/09/22-29/09/24 and systematic reviews

Results: 4

5. (title:(bed wound* OR bed ulcer* ) OR abstract:(bed wound* OR bed ulcer*)) OR (title:(bed sore* OR bed lesion*) OR abstract:(bed sore* OR bed lesion*)) OR (title:(bed injur*) OR abstract:(bed injur*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*))

Limit by publication year 2022,2023,2024 and added to database 01/09/22-29/09/24 and systematic reviews

Results: 0

6. (title:(bed bound OR bed-bound) OR abstract:(bed bound* OR bed-bound)) OR (title:(bedridden) OR abstract:(bedridden)) OR (title:(bed-ridden) OR abstract:(bed-ridden)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*))

Limit by publication year 2022,2023,2024 and added to database 01/09/22-29/09/24 and systematic reviews

Results: 0

7. (title:(supine OR immobil*) OR abstract:(supine OR immobil*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*)) AND (title:(heal OR healing OR heals OR healed OR dress*) OR abstract:(heal OR healing OR heals OR healed OR dress*))

Limit by publication year 2022,2023,2024 and added to database 01/09/22-29/09/24 and systematic reviews

Results: 4

8. (title:(supine OR immobil*) OR abstract:(supine OR immobil*)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*)) AND (title:(wound* OR ulcer* OR sore* OR injur* OR lesion*) OR abstract:(wound* OR ulcer* OR sore* OR injur* OR lesion*))

Limit by publication year 2022,2023,2024 and added to database 01/09/22-29/09/24 and systematic reviews

Results: 12

9. (title:(pressure OR bedbound OR bedridden OR bed-bound OR bed-ridden OR deep tissue OR deep-tissue) OR abstract:(pressure OR bedbound OR bedridden OR bed-bound OR bed-ridden OR deep tissue OR deep-tissue)) AND (title:(prevalen* OR epidemiolog* OR incidence*) OR abstract:(prevalen* OR epidemiolog* OR incidence*)) AND (title:(heal OR healing OR heals OR healed OR dress*) OR abstract:(heal OR healing OR heals OR healed OR dress*))

Limit by publication year 2022,2023,2024 and added to database 01/09/22-29/09/24 and systematic reviews

Results 85 before deduplication

 

Cinahl search

Date run: 26 September 2024

S1 ( ((TI decubit* OR AB decubit*) OR (TI bedsore* OR AB bedsore*) OR (TI bed-sore* OR AB bed-sore*) OR (TI pressure-ulcer* OR AB pressure-ulcer*) OR (TI pressure-wound* OR AB pressure-wound*)) ) OR ( (((TI pressure* OR AB pressure*) OR (TI bed OR AB bed) OR (TI bedbound OR AB bedbound) OR (TI bed-bound OR AB bed-bound) OR (TI bedridden OR AB bedridden) OR (TI bed-ridden OR AB bed-ridden) OR (TI “deep tissue*” OR AB “deep tissue*”) OR (TI deep-tissue OR AB deep-tissue)) N3 ((TI wound* OR AB wound*) OR (TI ulcer* OR AB ulcer*) OR (TI sore* OR AB sore*) OR (TI injur* OR AB injur*) OR (TI lesion* OR AB lesion*))) ) OR ( (MH “pressure ulcer”+) OR (MH pressure) ) (28,964)

S2 ( ((TI heal OR AB heal) OR (TI healing OR AB healing) OR (TI heals OR AB heals) OR (TI healed OR AB healed) OR (TI dress* OR AB dress*))) ) OR ( (((TI supine OR AB supine) OR (TI immobil* OR AB immobil*)) N3 ((TI wound* OR AB wound*) OR (TI ulcer* OR AB ulcer*) OR (TI sore* OR AB sore*) OR (TI injur* OR AB injur*) OR (TI lesion* OR AB lesion*))) ) OR ( (((TI pressure OR AB pressure) OR (TI bedbound OR AB bedbound) OR (TI bedridden OR AB bedridden) OR (TI bed-bound OR AB bed-bound) OR (TI bed-ridden OR AB bed-ridden) OR (TI “deep tissue” OR AB “deep tissue”) OR (TI deep-tissue OR AB deep-tissue)) N3 ((TI heal OR AB heal) OR (TI healing OR AB healing) OR (TI heals OR AB heals) OR (TI healed OR AB healed) OR (TI dress* OR AB dress*))) ) (72,997)

S3 S1 OR S2 (97,252)

S4 ( ((TI prevalen* OR AB prevalen*) OR (TI epidemiolog* OR AB epidemiolog*) OR (TI incidence* OR AB incidence*)) ) OR (MH epidemiology+) OR (MH prevalence+) OR (MH incidence+) (1,165,006)

S5 S3 AND S4 (12,459)

S6 ( (PT “systematic review” OR PT meta-analysis) ) OR ( (MH meta-analysis) OR (MH “systematic review”) OR (MH “systematic reviews as topic”) OR (MH “meta-analysis as topic”) OR (MH “meta analysis (topic)”) OR (MH “systematic review (topic)”) OR (MH “technology assessment, biomedical”+) OR (MH “network meta-analysis”) ) OR ( (((TI systematic* OR AB systematic* OR SU systematic*) N3 ((TI review* OR AB review* OR SU review*) OR (TI overview* OR AB overview* OR SU overview*))) OR ((TI methodologic* OR AB methodologic* OR SU methodologic*) N3 ((TI review* OR AB review* OR SU review*) OR (TI overview* OR AB overview* OR SU overview*)))) ) OR ( (((TI quantitative OR AB quantitative OR SU quantitative) N3 ((TI review* OR AB review* OR SU review*) OR (TI overview* OR AB overview* OR SU overview*) OR (TI synthes* OR AB synthes* OR SU synthes*))) OR ((TI research OR AB research OR SU research) N3 ((TI integrati* OR AB integrati* OR SU integrati*) OR (TI overview* OR AB overview* OR SU overview*)))) ) OR ( (((TI integrative OR AB integrative OR SU integrative) N3 ((TI review* OR AB review* OR SU review*) OR (TI overview* OR AB overview* OR SU overview*))) OR ((TI collaborative OR AB collaborative OR SU collaborative) N3 ((TI review* OR AB review* OR SU review*) OR (TI overview* OR AB overview* OR SU overview*))) OR ((TI pool* OR AB pool* OR SU pool*) N3 (TI analy* OR AB analy* OR SU analy*))) ) OR ( ((TI “data synthes*” OR AB “data synthes*” OR SU “data synthes*”) OR (TI “data extraction*” OR AB “data extraction*” OR SU “data extraction*”) OR (TI “data abstraction*” OR AB “data abstraction*” OR SU “data abstraction*”)) ) OR ( ((TI handsearch* OR AB handsearch* OR SU handsearch*) OR (TI “hand search*” OR AB “hand search*” OR SU “hand search*”)) ) OR ( ((TI “mantel haenszel” OR AB “mantel haenszel” OR SU “mantel haenszel”) OR (TI peto OR AB peto OR SU peto) OR (TI “der simonian” OR AB “der simonian” OR SU “der simonian”) OR (TI dersimonian OR AB dersimonian OR SU dersimonian) OR (TI “fixed effect*” OR AB “fixed effect*” OR SU “fixed effect*”) OR (TI “latin square*” OR AB “latin square*” OR SU “latin square*”)) ) OR ( ((TI “met analy*” OR AB “met analy*” OR SU “met analy*”) OR (TI metanaly* OR AB metanaly* OR SU metanaly*) OR (TI “technology assessment*” OR AB “technology assessment*” OR SU “technology assessment*”) OR (TI HTA OR AB HTA OR SU HTA) OR (TI HTAs OR AB HTAs OR SU HTAs) OR (TI “technology overview*” OR AB “technology overview*” OR SU “technology overview*”) OR (TI “technology appraisal*” OR AB “technology appraisal*” OR SU “technology appraisal*”)) ) OR ( ((TI “meta regression*” OR AB “meta regression*” OR SU “meta regression*”) OR (TI metaregression* OR AB metaregression* OR SU metaregression*)) ) OR ( (meta-analy* OR metaanaly* OR “systematic review*” OR “biomedical technology assessment*” OR “bio-medical technology assessment*”) ,hw. ) OR ( ((TI medline OR AB medline) OR (TI cochrane OR AB cochrane) OR (TI pubmed OR AB pubmed) OR (TI medlars OR AB medlars) OR (TI embase OR AB embase) OR (TI cinahl OR AB cinahl)) ,hw. ) (272,919)

S7 ( (cochrane OR ( health N2 “technology assessment”) OR “evidence report”) .jw. ) OR ( ((TI comparative OR AB comparative OR SU comparative) N3 ((TI efficacy OR AB efficacy OR SU efficacy) OR (TI effectiveness OR AB effectiveness OR SU effectiveness))) ) OR ( ((TI “outcomes research” OR AB “outcomes research” OR SU “outcomes research”) OR (TI “relative effectiveness” OR AB “relative effectiveness” OR SU “relative effectiveness”)) ) OR ( (((TI indirect OR AB indirect OR SU indirect) OR (TI “indirect treatment” OR AB “indirect treatment” OR SU “indirect treatment”) OR (TI mixed-treatment OR AB mixed-treatment OR SU mixed-treatment) OR (TI bayesian OR AB bayesian OR SU bayesian)) N3 (TI comparison* OR AB comparison* OR SU comparison*)) ) OR ( ((TI multi* OR AB multi* OR SU multi*) N3 (TI treatment OR AB treatment OR SU treatment) N3 (TI comparison* OR AB comparison* OR SU comparison*)) ) OR ( (TI “umbrella review*” OR AB “umbrella review*” OR SU “umbrella review*”) ) OR ( ((TI multi* OR AB multi* OR SU multi*) N2 (TI paramet* OR AB paramet* OR SU paramet*) N2 (TI evidence OR AB evidence OR SU evidence) N2 (TI synthesis OR AB synthesis OR SU synthesis)) ) OR ( ((TI multiparamet* OR AB multiparamet* OR SU multiparamet*) N2 (TI evidence OR AB evidence OR SU evidence) N2 (TI synthesis OR AB synthesis OR SU synthesis)) ) OR ( ((TI multi-paramet* OR AB multi-paramet* OR SU multi-paramet*) N2 (TI evidence OR AB evidence OR SU evidence) N2 (TI synthesis OR AB synthesis OR SU synthesis)) ) (20,064)

S8 ((TI search: OR AB search:)) (132,562)

S9 PT review (369,186)

S10 S6 OR S7 OR S8 OR S9 (693,443)

S11 S5 AND S10 (1,855)

S12 (EM 20220101- OR (ZD “in process” AND RD 20220101-))

S13 S11 AND S12 (347)

 

Supplementary Table S2

The list of excluded studies with the reason of exclusion.