Pressure ulcers (pressure injuries): evidence and resources

On this page you can find Cochrane evidence on preventing and treating pressure ulcers (pressure injuries), including resources that aim to make it useful and accessible, as well as links to the reviews themselves.

You can either scroll through this page or click on the topics below to jump to a particular section. 

Page last updated 22 December 2022



Risk assessment tools

Key message: “The low, or very low certainty of evidence available from the [two] included studies is not reliable enough to suggest that the use of structured and systematic pressure ulcer risk assessment tools reduces the incidence or severity of pressure ulcers.”

 Read the full Cochrane Review: Risk assessment tools for the prevention of pressure ulcers (January 2019)

 Read the Cochrane Clinical Answer: Does the use of risk assessment tools help prevent the development of pressure ulcers? 


Support surfaces

In the blog Support surfaces for managing pressure ulcers: which to choose? Chunhu Shi, a nurse and lead author of a Cochrane Overview shares what the latest evidence tells us about support surfaces for managing pressure ulcers, and what we still don’t know.

A Cochrane Overview of five Cochrane Reviews with network meta-analysis has made multiple comparisons of different support surfaces (medical grade beds, mattresses or overlays) Overall, it is unclear which support surface is best in preventing and treating pressure ulcers, but the evidence suggests that: A reactive air surface (such as a static air mattress) may be better than a foam surface (such as a foam mattress) for preventing and healing pressure ulcers Alternating pressure air surfaces (such as alternating pressure air mattresses or overlays) may be better than foam surfaces for preventing pressure ulcers, and probably cost less in relation to their benefit in preventing ulcers Reactive gel surfaces (such as gel pads used on operating tables) may be better than foam surfaces for preventing pressure ulcers

 Read the full Cochrane Overview: Beds, overlays and mattresses for preventing and treating pressure ulcers: an overview of Cochrane Reviews and network meta-analysis (August 2021)

 Read the Cochrane Clinical Answers:

Read also the full Cochrane Review Pressure redistributing static chairs for preventing pressure ulcers (February 2022) published since the overview on support surfaces.

It concludes “There is no randomised evidence that supports or refutes the role of pressure redistributing static chairs in the prevention or management of pressure ulcers. This is a priority area and there is a need to explore this intervention with rigorous and robust research.” The NICE guideline takes this up, making a research recommendation: “Do pressure redistributing devices reduce the development of pressure ulcers for those who are at risk of developing a pressure ulcer? The currently empty Cochrane Review (February 2022) on pressure redistributing static chairs for preventing pressure ulcers, which you include in the blog, affirms the need for this research, especially considering the cost of these chairs: the UK NHS Supply Chain (2022) lists 307 chairs ranging in cost from £270 to £2500. Efficacy and cost-effectiveness still need to be established.”



Repositioning for prevention of pressure ulcers/pressure injuries

Key messages:

  • “There remains a lack of robust evaluations of repositioning frequency and positioning for PI prevention and uncertainty about their effectiveness.
  • It remains unclear whether repositioning every three hours using the 30° tilt versus “usual care” (90° tilt) or repositioning 3‐to‐4‐hourly versus 2‐hourly is less costly relative to nursing time.”

 Read the full Cochrane Review: Repositioning for pressure injury prevention in adults (June 2020)

 Read the Cochrane Clinical Answers:

Repositioning for treatment of pressure ulcers/pressure injuries

Key message: “Despite the widespread use of repositioning as a component of the management plan for individuals with existing pressure ulcers, no randomised trials exist that assess the effects of repositioning patients on the healing rates of pressure ulcers.”

 Read the full Cochrane Review: Repositioning for treating pressure ulcers (January 2015)


Dressings and topical agents

Key message: “we are unable to determine which dressings or topical agents are the most likely to heal pressure ulcers”.

Maggie Westby, Jo Dumville and Gill Norman, three of the authors of the Cochrane Review ‘Dressings and topical agents for treating pressure ulcers’ (June 2017), explain more in their blog Dressings and topical agents for healing pressure ulcers: which should we choose?, including what network meta-analysis is and how they used it to compare treatments.

 Read the full Cochrane Review: Dressings and topical agents for treating pressure ulcers (June 2017)

 Read the Cochrane Clinical Answer: How do different dressings and topical agents compare for treating individuals with pressure ulcers?


Evidence-based practice?

Evidently Cochrane blogs:


NICE Guidance on pressure ulcers

National Clinical Guideline Centre, National Institute for Health and Care Excellence (commissioner). Pressure ulcer management: the prevention and management of pressure ulcers in primary and secondary care. London: National Institute for Health and Care Excellence; 2014 (NICE CG179). [Issued April 2014]. Available from:



Addressing a priority research question identified by the James Lind Alliance Priority Setting Partnership on Pressure ulcers, the Cochrane Review Reconstructive surgery for treating pressure ulcers (published October 2022) concludes “Currently there is very little randomised evidence on the role of reconstructive surgery in pressure ulcer management, although it is considered a priority area. More rigorous and robust research is needed to explore this intervention.”


Join in the conversation on Twitter with @CochraneUK @SarahChapman30 or leave a comment on the blog.

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References (pdf)

Sarah Chapman has nothing to disclose.


Pressure ulcers (pressure injuries): evidence and resources by Sarah Chapman

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