Documentos da Atenção Primária à Saúde para o tratamento de feridas crônicas: uma revisão sistemática de evidências textuais

Abstract

This study aimed to evaluate the documents used for the treatment of chronic wounds adopted in Primary Health Care (PHC) in Brazil, through a systematic review of textual evidence. A total of 21 documents (protocols, manuals, and municipal guidelines) were included, identified through structured searches in national and international databases (Cochrane Library, Scopus, Web of Science, Lilacs/BVS) and gray literature sources. The review followed the methodology proposed by the Joanna Briggs Institute (JBI) for textual evidence reviews, and also incorporated an assessment of the methodological quality of the documents using the AGREE II instrument. The clinical evidence extracted was organized into nine thematic blocks covering essential elements of chronic wound care, including clinical foundations, assessment tools, topical therapies, and referral pathways. The results revealed wide variability in content, with several documents presenting incomplete or outdated approaches. Although most address basic aspects such as anatomy, wound healing phases, and general classifications, there was a notable absence or insufficient development of critical elements such as risk stratification, use of tools like TIME, and specific guidelines for complex wounds of certain etiologies, such as neoplastic, neuropathic, and arterial ulcers. The methodological analysis showed low scores in the domains of rigor of development, stakeholder involvement, and editorial independence, highlighting weaknesses in the construction process of many documents. These findings raise concerns about the reliability and practical applicability of the analyzed protocols. It is concluded that, although the existence of care protocols contributes to the standardization of practices and supports the work of PHC professionals, significant gaps persist that limit their effectiveness. The development of high-quality protocols must be based on up-to-date scientific evidence, participatory construction, and systematic validation in order to ensure safe, ethical, and effective care for people with chronic wounds.