Predicting venous leg ulcer healing

Aim: Despite advances in wound care, chronic venous leg ulcers still pose a considerable burden and contribute to high health care costs. At present, clinicians around the world utilise their own expert judgement when considering whether a venous leg ulcer will be difficult to heal. We have published a screening tool to assist clinicians to detect leg ulcers at-risk of delayed healing and have internationally validated this tool for early identification of those at risk of delayed healing of venous leg ulcers by 24 weeks. Methods: A 10-item tool including socio-demographic, venous history, ulcer and lower limb characteristics, compression and mobility items to determine the risk of delayed healing of venous leg ulcers has previously been developed and validated in Australia. This tool was prospectively validated using Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) analysis in the international populations of United Kingdom (UK), Austria and New Zealand.Results: One hundred and forty-one participants were recruited internationally. Participants enrolled from one hospital clinic in UK (n=43, 30.5%), one hospital clinic in Melk, Austria (n=14, 9.9%) and two community clinics in New Zealand (n=84, 59.6%). Seventy per cent (n=96) healed by 24 weeks, while 30% (n=41) had not healed. The validation in UK, Austria and New Zealand has indicated that the model has moderate discrimination and goodness-of-fit with an AUC of 0.74 (95% CI, 0.66-0.82) for the total risk assessment score.Discussion: This innovative risk assessment tool for early detection of risk of non-healing in venous leg ulcers has been tested for validity and reliability. The validation of this risk assessment tool offers a simple, easy to use tool for all clinicians to determine realistic outcomes for their patients and guide early clinical decision making for alternative, tailored interventions to address the specific risk factors and thus promote early healing