Ulcer area reduction at 2 weeks predicts failure to heal by 24 weeks in the venous leg ulcers of patients living alone

作者：Parker C N^*; Finlayson K J; Edwards H E

来源：Journal of Wound Care, 2016, 25(11): 626-634.

DOI：10.12968/jowc.2016.25.11.626

• delayed healing
• generalised linear mixed modelling
• non-healing
• risk factors
• venous leg ulcer
• living alonesupplies

Objective: Chronic wounds are costly and affect approximately 1-2% of the population. Venous disease is responsible for about 60% of all chronic leg ulcers and these ulcers can be debilitating, with evidence of a decreased quality of life. Unfortunately, up to 30% of venous leg ulcers (VLUs) fail to heal, despite best practice treatment. This study aimed to identify risk factors associated with delayed healing in participants with VLUs and in particular, whether psychosocial factors play a part in this process.
Method: A secondary analysis was conducted of a large data set of clinical, wound healing, health, social, economic and psychological data collected in previous prospective studies of participants with VLUs. Generalised linear mixed modelling was used to identify independent predictors of failure to heal after 24 weeks.
Results: We recruited 247 participants with 318 VLUs from hospital and community settings. Findings revealed that four early predictors were independently significantly associated with failure to heal by 24weeks. These were: participants who lived alone (OR 2.3, 95% CI [1.13-4.61], p= 0.03); had less than 25% reduction in ulcer area within two weeks of treatment (OR 10.07, 95% CI [4.60-22.19], p<0.001); had higher ulcer severity scores (OR 5.1, 95% CI [2.33-11.88], p= 0.001); and participants who were not treated with high level compression therapy (i.e.>30mmHg) at the time of assessment (OR 4.18,95% CI [1.95-8.97], p=0.002).
Conclusion: Identified risk factors offer an opportunity for clinicians to determine realistic outcomes for their patients and to guide decisions on early referral and implementation of tailored adjunctive interventions. Additionally, findings from this study suggest health professionals need to assess and address not only clinical risk factors but also social risk factors, when planning interventions to promote healing.
eclaration of interest: This study was supported by a Queensland University of Technology, Faculty of Health Masters Scholarship, a National Health and Medical Research Council Primary Health Care Postgraduate Research Scholarship, an Australian College of Nursing Margaret Y Winning Queensland Nursing Scholarship and the Wound Management Innovation CRC (established and supported under the Australian Government's Cooperative Research Centres Program).

• 出版日期2016-11