Evidence-based chronic ulcer care and lower limb outcomes among Pacific Northwest veterans

• Published in: Wound repair and regeneration 2015-09, Vol.23 (5), p.745-752
• Main Authors: Karavan, Mahsa, Olerud, John, Bouldin, Erin, Taylor, Leslie, Reiber, Gayle E.
• Format: Article
• Language: English
• Subjects: Aged; Chronic Disease; Compression Bandages; Debridement - methods; evidence-based care; Evidence-Based Medicine - methods; Female; Humans; Incidence; Leg Ulcer - epidemiology; Leg Ulcer - therapy; lower limb; Male; Negative-Pressure Wound Therapy - methods; Northwestern United States - epidemiology; Retrospective Studies; Treatment Outcome; ulcer; Veterans; Wound Healing
• ISSN: 1067-1927; 1524-475X
• DOI: 10.1111/wrr.12341

ABSTRACT Evidence‐based ulcer care guidelines detail optimal components of care for treatment of ulcers of different etiologies. We investigated the impact of providing specific evidence‐based ulcer treatment components on healing outcomes for lower limb ulcers (LLU) among veterans in the Pacific Northwest. Components of evidence‐based ulcer care for venous, arterial, diabetic foot ulcers/neuropathic ulcers were ed from medical records. The outcome was ulcer healing. Our analysis assessed the relationship between evidence‐based ulcer care by etiology, components of care provided, and healing, while accounting for veteran characteristics. A minority of veterans in all three ulcer‐etiology groups received the recommended components of evidence‐based care in at least 80% of visits. The likelihood of healing improved when assessment for edema and infection were performed on at least 80% of visits (hazard ratio [HR] = 3.20, p = 0.009 and HR = 3.54, p = 0.006, respectively) in patients with venous ulcers. There was no significant association between frequency of care components provided and healing among patients with arterial ulcers. Among patients with diabetic/neuropathic ulcers, the chance of healing increased 2.5‐fold when debridement was performed at 80% of visits (p = 0.03), and doubled when ischemia was assessed at the first visit (p = 0.045). Veterans in the Pacific Northwest did not uniformly receive evidence‐based ulcer care. Not all evidence‐based ulcer care components were significantly associated with healing. At a minimum, clinicians need to address components of ulcer care associated with improved ulcer healing.