A Predictive Model for Pressure Ulcer Outcome: The Wound Healing Index

作者：Horn Susan D^*; Barrett Ryan S; Fife Caroline E; Thomson Brett

来源：Advances in Skin and Wound Care: The Journal for Wound Prevention and Healing , 2015, 28(12): 560-572.

DOI：10.1097/01.ASW.0000473131.10948.e7

• predictive model
• pressure ulcers
• patient outcome
• Qualified Clinical Data Registry
• wound registry

PURPOSE: The purpose of this learning activity is to provide information regarding the creation of a risk-stratification system to predict the likelihood of the healing of body and heel pressure ulcers (PrUs).
TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.
OBJECTIVES: After participating in this educational activity, the participant should be better able to: 1. Explain the need for a PrU risk stratification tool. 2. Describe the purpose and methodology of the study. 3. Delineate the results of the study and development of the Wound Healing Index.
ABSTRACT OBJECTIVE: To create a validated system to predict the healing likelihood of patients with body and heel pressure ulcers (PrUs), incorporating only patient- and wound-specific variables.
DESIGN: The US Wound Registry data were examined retrospectively and assigned a clear outcome (healed, amputated, and so on). Significant variables were identified with bivariate analyses. Multivariable logistic regression models were created based on significant factors (P < .05) and tested on a 10% randomly selected hold-out sample.
SETTING: Fifty-six wound clinics in 24 states
PATIENTS: A total of 7973 body PrUs and 2350 heel PrUs were eligible for analysis.
INTERVENTION: Not applicable
MAIN OUTCOME MEASURE: Healed PrU
MAIN RESULTS: Because of missing data elements, the logistic regression development model included 6640 body PrUs, of which 4300 healed (64.8%), and the 10% validation sample included 709 PrUs, of which 477 healed (67.3%). For heel PrUs, the logistic regression development model included 1909 heel PrUs, of which 1240 healed (65.0%), and the 10% validation sample included 203 PrUs, of which 133 healed (65.5%). Variables significantly predicting healing were PrU size, PrU age, number of concurrent wounds of any etiology, PrU Stage III or IV, evidence of bioburden/infection, patient age, being nonambulatory, having renal transplant, paralysis, malnutrition, and/or patient hospitalization for any reason.
CONCLUSIONS: Body and heel PrU Wound Healing Indices are comprehensive, user-friendly, and validated predictive models for likelihood of body and heel PrU healing. They can risk-stratify patients in clinical research trials, stratify patient data for quality reporting and benchmarking activities, and identify patients most likely to require advanced therapeutics to achieve healing.

• 出版日期2015-12