An umbrella review of systematic reviews and meta-analysis of prevalence and incidence of pressure injuries in the United States

What is it about?

Background: Pressure injuries (PIs) are a significant public health concern in the USA, contributing to patient morbidity, mortality and healthcare costs. Epidemiological and health economic research relies on robust estimates of PI prevalence and incidence to inform resource allocation and preventive strategies. Aim: This systematic review aimed to assess the feasibility of a meta-meta-analysis (meta-MA) to estimate the prevalence or incidence of PIs in the USA. Methods: The umbrella review of systematic reviews (SRs) with meta-analyses (MAs) published between January 2010 and September 2024 was conducted. Searches were performed in four databases. Two reviewers independently screened articles, one extracted data, and another verified data points. Quality was assessed using AMSTAR-2, and feasibility of a meta-MA was evaluated based on SR quality, study overlap, population and outcome similarities, and inclusion of US-specific studies or subgroup analyses. Results: Twenty SRs with MAs were identified. Overall quality was poor, with two high-quality and one moderate-quality study. Overlap was minimal. Population characteristics and outcome definitions were poorly reported; only four SRs properly defined outcomes. Three SRs focused on the general hospitalised population, nine on subgroups, five on device-related PIs, and 13 on specific settings. Sixteen SRs included ≥2 US studies, but only six performed country subgroup analyses. Conclusions: A robust meta-MA to support US health economic modeling was not feasible. Implications for clinical practice: PI point prevalence remains high, but the low quality of SRs limits the ability to delineate a clear epidemiological picture, underscoring the need for higher-quality reviews.

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