Friday, July 13, 2007
This presentation is part of : Measurement Outcomes
Chronic Wounds: Severity, Treatment, and Outcomes
Katherine Jones, RN, PhD, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
Learning Objective #1: Describe the wound characteristics that contribute to a wound severity score
Learning Objective #2: Examine which case-mix, socio-demographic, and treatment variables predict selected healing outcomes

Background: Chronic ulcers affect millions of people, and are a growing clinical problem seen most frequently in the elderly. Nonhealing or slow healing wounds represent a major health burden and drain on resources, contributing to substantial disability, morbidity, and cost. Basic principles of good wound care are known (manage exudate, remove necrotic tissue, treat infection), but the evidence supporting specific dressings, debridement approaches, and secondary therapies remains limited.


Purpose: The purpose of this study was to determine the extent to which wound severity, demographics, comorbid conditions, risk factors, and selected therapies influenced wound healing in older adults.


Methods: This retrospective chart review study used a structured data abstraction protocol. Trained research assistants at four sites in the US reviewed the closed records of subjects treated for chronic pressure, diabetic, or venous ulcers. Data were recorded at monthly intervals over a 6 month period.  


Results: A total of 400 subjects were included in our database: 114 pressure, 103 diabetic, and 183 venous. Sample description was: 72.7 years old, 56.5% female, 60.6% white, 34.7% married, and 72.7% Medicare. Severity scores ranged from 0 to 15. Bivariate analysis showed that higher severity scores were associated with not healing, Medicaid insurance, enzymatic and autolytic debridement, and nutritional support. Controlling for wound severity in multivariate logistic regression models, Medicaid, more dressing type changes, higher percent antimicrobial dressings, more frequent sharp debridement, more frequent enzymatic debridement, and more instances of inappropriate debridement management, all decreased the odds of healing. Wound severity, greater use of mechanical debridement, topical antiseptics, and antimicrobial dressings, and more dressing type changes all increased the odds of not healing.


Conclusions: Although wound severity plays a role in chronic wound healing, specific treatment approaches selected by clinicians also affect healing. Improving treatment decisions might improve chronic ulcer healing rates.