A systematic review of clinical practice guidelines and other best practice recommendations for pressure injury risk assessment in the United States

Abstract

Preventing pressure injuries (PIs) remains the most effective way to reduce their burden. A key element of prevention is the assessment of PI risk. The study aimed to investigate whether guidance documents relevant to the United States (US) advocated for specific risk assessment recommendations. We conducted a systematic review of guidance documents published between 2010 and 2024. Embase, Medline, Cinahl, and four key organisational websites were systematically searched to retrieve relevant articles. Two independent reviewers screened the articles for inclusion. One reviewer extracted the data, and a second reviewer checked all extracted data. Three reviewers assessed the guidance documents quality using the Appraisal of Guidelines for Research & Evaluation (AGREE II) tool. A narrative synthesis was used to describe and summarise findings. Six clinical practice guidelines (CPGs) and eight other best practice recommendations were included. The median scores of most AGREE II domains were higher for CPGs compared to other best practice recommendations. Risk assessment was consistently positioned as a critical first step in the prevention of PIs, emphasising its role in identifying at-risk individuals and informing targeted interventions. Although risk assessment was presented as a crucial step in PI risk prevention, there was no clear and unanimous recommendation for a specific risk assessment strategy across all guidance documents, either for the general population or for specific subgroups of patients in US healthcare settings. These findings suggest a need for national consensus on concepts, implementation, and language addressing PI risk assessment.

Keywords: best practice recommendation; clinical practice guideline; evidence‐based practice; pressure injury; preventive health services; risk assessment.

FIGURE 1

The PRISMA flow diagram.

FIGURE 2

Median AGREE II domain scores and ranges for CPGs and other best practice recommendations. The red horizontal line at 50% indicates the cut‐off score at or above which each domain was considered ‘properly addressed’. A grey dot indicates the score for the higher‐quality CPGs, while a black dot refers to the score for the lower‐quality CPGs and other best practice recommendations.