The incremental cost-effectiveness ratio was GBP 267,910 and NPWT was shown to be unlikely to be cost effective at a range of cost-per-QALYs thresholds. On average, NPWT was more costly and conferred few additional quality-adjusted life years (QALYs) when compared with standard care. On average, it is uncertain whether NPWT at 125 mmHg reduces the risk of wound infection compared with standard care (RR 0.48, 95% CI 0.20 to 1.13 I 2 = 56%) very low-certainty evidence downgraded for risk of bias, inconsistency and imprecision.Data from one study shows that there is probably no clear difference in health-related quality of life between participants treated with NPWT 125 mmHg and those treated with standard wound care (EQ-5D utility scores mean difference (MD) -0.01, 95% CI -0.08 to 0.06 364 participants, moderate-certainty evidence physical component summary score of the short-form 12 instrument MD -0.50, 95% CI -4.08 to 3.08 329 participants low-certainty evidence downgraded for imprecision).Moderate-certainty evidence from one trial (460 participants) suggests that NPWT is unlikely to be a cost-effective treatment for open fractures in the UK. Follow-up varied between studies but was approximately 30 days. At six weeks there was no clear difference between groups in the number of participants with a healed, open fracture wound: risk ratio (RR) 1.01 (95% confidence interval (CI) 0.81 to 1.27) moderate-certainty evidence, downgraded for imprecision.We pooled data on wound infection from four studies (596 participants). One further study compared NPWT at 75 mmHg with standard care and NPWT 125mmHg with NPWT 75 mmHg.Open fracture wounds (four studies all comparing NPWT 125 mmHg with standard care)One study (460 participants) comparing NPWT 125 mmHg with standard care reported the proportions of wounds healed in each arm. Six studies compared NPWT at 125 mmHg with standard care: one of these studies did not report any relevant outcome data. One study had three arms, which were all included in the review. Study sample sizes ranged from 40 to 586 participants. Seven RCTs (1377 participants recruited) met the inclusion criteria of this review. Data were presented and analysed separately for open fracture wounds and other open traumatic wounds (not involving a broken bone). Two review authors independently selected eligible studies, extracted data, carried out a 'Risk of bias' assessment and rated the certainty of the evidence. Wound healing, wound infection and adverse events were our primary outcomes. Published and unpublished randomised controlled trials that used NPWT for open traumatic wounds involving either open fractures or soft tissue wounds. There were no restrictions with respect to language, date of publication or study setting. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. In June 2018 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase and EBSCO CINAHL Plus. To assess the effects of NPWT for treating open traumatic wounds in people managed in any care setting. There are no systematic reviews assessing the effectiveness of NPWT for traumatic wounds. The treatment aims to support wound management, to prepare wounds for further surgery, to reduce the risk of infection and potentially to reduce time to healing (with or without surgical intervention). This medical device involves the application of a wound dressing through which negative pressure is applied and tissue fluid drawn away from the area. In some cases these wounds are left open and negative pressure wound therapy (NPWT) is used as a treatment. Two key types of traumatic wounds considered in this review are those that damage soft tissue only and those that involve a broken bone, that is, open fractures. Traumatic wounds (wounds caused by injury) range from abrasions and minor skin incisions or tears, to wounds with extensive tissue damage or loss as well as damage to bone and internal organs.
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