Use or misuse of colostomy to heal pressure ulcers.

PURPOSE: The purpose of this study is to evaluate the effectiveness of colostomy performed as an adjunct measure in the attempt to heal pressure ulcers by flap closure. METHODS: Twenty-seven consecutive patients who underwent colostomy for healing of pressure ulcers were studied by chart review and patient questionnaire. Fecal diversion was accomplished by colostomy in each case. RESULTS: There were four (15 percent) deaths. Twenty-three patients subsequently underwent flap closure of their ulcer. Of 19 patients available for follow-up, only 6 (32 percent) patients had completely healed, although most patients thought their quality of life improved because of the colostomy. None of the patients underwent colostomy closure. CONCLUSION: Our conclusions are that, although most patients will have an improved quality of life subsequent to diversion, the high mortality and low rate of pressure ulcer healing should temper enthusiasm for performing colostomy in this setting.

Pressure ulcer risk assessment--simple or complex?

A descriptive comparison study was carried out to determine whether there was a difference between a staff nurse's single-item pressure ulcer risk assessment and a risk assessment using the Braden Scale. Seventy-two medical patients participated in the study. Statistical analysis of the data indicated nurses were accurate in predicting pressure ulcer risk with a simple YES/NO answer. The mean Braden Score for those patients indicated at risk by the nurse was 14.45, and 20.24 for those assessed to be not at risk. This study indicates that nurses' good judgement is as reliable as more complicated tools in determining pressure ulcer risk. Further studies comparing risk assessment tools are recommended.