How precise is the evaluation of chronic wounds by health care professionals?
Chronic wounds are a growing challenge for physicians and health insurance agencies. The burden of affected patients is enormous, because of pain but also because of long-lasting therapies and dependence on nursing services. In other areas of medicine, computer-based diagnostics is established, yet, accurate wound documentation is rarely conducted and is often limited to size measurement with a ruler and a rough photo documentation. Objective assessment of lesions by evaluation of granulation tissue, fibrin coverage and necrosis is not performed. The aim of this study was to investigate the spread and variety in judgement of a chronic wound. A diabetic ulcer was described by 16 wound therapists (eight physicians and eight nurses). Granulation tissue, fibrin coverage, necrosis, size and depth of the lesion, wound exudate and wound edges were judged, and the therapeutical consequences were determined. Study data show an extensive inhomogeneity and a wide spread of the results, like in no other field of medical diagnostics. This could be shown in the group of physicians, as well as in the group of nursing personnel. As the choice of treatment by a specialist is based upon the assessment of the wound, it is possible that in practice it can lead to suboptimal therapy. This is a consequence of varying treating physicians and subsequent changes in treatment regimens. This results in a prolongation of treatment and burden for the patient. Circumstances like this contribute to rising of costs in this area of the health care system. The goal is to apply objective wound diagnostic technologies in the field of chronic wounds to catch up with other diagnostic procedures.
Stremitzer
Stefan
S
Department of General Surgery, Medical University Vienna, General Hospital Vienna, Austria. stefan.stremitzer@meduniwien.ac.at
Wild
Thomas
T
Hoelzenbein
Thomas
T
D002908:Chronic Disease; D002983:Clinical Competence; D017719:Diabetic Foot / Q000473:pathology*; D005337:Fibrin; D006097:Granulation Tissue / Q000473:pathology; D006801:Humans; D009336:Necrosis / Q000473:pathology; D009726:Nurses; D015588:Observer Variation; D010820:Physicians; D015203:Reproducibility of Results; D014945:Wound Healing
D005337:Fibrin