A Predictive Model for Pressure Ulcer Outcome: The Wound Healing Index. (December 2015)

• Record Type: Journal Article
• Authors: Horn, Susan D.; Barrett, Ryan S.; Fife, Caroline E.; Thomson, Brett
• Is Part Of: Advances in skin & wound care. Volume 28:Number 12(2015)
• Publication Date: 2015-12
• Subjects: predictive model -- pressure ulcers -- patient outcome -- Qualified Clinical Data Registry -- wound registry; Wounds and injuries -- Treatment -- Periodicals; Wound healing -- Periodicals; Skin -- Diseases -- Treatment -- Periodicals; Dermatology -- United States -- Periodicals; 617.106
• DOI: 10.1097/01.ASW.0000473131.10948.e7
• Languages: English
• ISSNs: 1527-7941

Abstract

Abstract : 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.