Risk factors for the development and evolution of deep tissue injuries: A systematic review

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It is now recognised that Deep Tissue Injury (DTI) has a unique clinical appearance. None the less, there is a paucity of information on the specific risk factors associated with DTI as well as what influences their outcomes.

The objective of this systematic review was to unearth and showcase current evidence on the epidemiological characteristics of DTI. The justification for this review was that a resultant outcome of determining specific risk factors for DTI may lead to more focused research in the area, generating knowledge unique to DTI prevention and treatment, knowledge which could lead to the generation of practice based preventative  and treatment interventions.

The review itself followed established steps which led to the identification and inclusion of 9 papers including 4 retrospective studies, 4 prospective studies and 1 animal study.

The take away points were that the majority of DTI occur at the heel and sacrum. But this is different in paediatrics where DTI occur mainly because of medical devices. In the main, most DTI resolve, although up to 27% can deteriorate to full thickness tissue loss. Evidence also identified risk factors associated most closely with DTI, such as anaemia, vasopressor use, haemodialysis and nicotine use. Crucially, for practitioners, the risk factors identified could become targets for preventative and management interventions.

What is now needed are more rigourous statistically powered prospective studies focusing on establishing evidence based links between risk factors and DTI. Additionally, more evidence is needed in the area of DTI and paediatrics.

View on the Journal of Tissue Viability website