—Thank you for allowing us to respond to concerns expressed by Dr Verdery regarding our article, which examined the clinical utility and cost-effectiveness of an air suspension bed in the prevention of pressure ulcers. First, he was concerned about the lack of blinding in the diagnosis and categorization of stage I ulcers. As stated in our methods, blinding was impossible. Therefore, we instituted a process to minimize this bias as much as possible. Specifically, with detection and staging of a pressure ulcer by the study nurse, our hospital's skin care team was consulted. The consultant dermatologist then independently addressed the issue of presence or absence of pressure ulcers and staged them when applicable. Our interrater agreement was good (κ>0.80). Second, Verdery noted we had not mentioned whether a specific treatment protocol was instituted. The study's objective was to address prevention, not treatment. Thus, treatment of established ulcers was
Critical care services have grown to consume a substantial role in health care with little emphasis on the evaluation of the technologies they routinely employ. Although the appropriate assessment of new technologies is becoming increasingly important, many critical care practitioners remain confused as to the methods of technology assessment. In this review we begin by defining terms commonly used in the technology assessment process. We then undertake a brief discussion of how the benefits of new technologies can be examined. Costs and their calculation are then discussed, followed by a brief discussion of those analyses that combine both costs and consequences. Finally, a framework for helping the individual practitioner evaluate or plan technology assessment protocols is presented.
To determine, in critically ill patients at risk, both the clinical utility and cost-effectiveness of using an air suspension bed in the prevention of pressure ulcers.Randomized, parallel group, controlled clinical trial with accompanying cost-effectiveness analysis.30-bed multidisciplinary intensive care unit.100 consecutive patients at risk for the development of pressure ulcers randomly assigned to receive treatment on either an air suspension bed or a standard intensive care unit bed. Patients considered at risk were those at least 17 years of age with an Acute Physiology and Chronic Health Evaluation II (APACHE II) score greater than 15 who had an expected intensive care unit stay of at least 3 days.The development of pressure ulcers by site and severity and the costs associated with each of the two programs.The air suspension bed was associated with fewer patients developing single, multiple, or severe pressure ulcers. In patients at risk, the use of an air suspension bed in the prevention of pressure ulcers was a cost-effective therapy.Despite intense nursing care, pressure ulcers are more prevalent in the critically ill patient population than in the general hospital population. Air suspension therapy provides a clinically effective means of preventing pressure ulcers in these patients. In patients at risk, air suspension therapy was a cost-effective means of managing pressure ulcers compared with the standard hospital bed.
