title: Wound emergencies: the importance of assessment, documentation, and early treatment using a wound electronic medical record.
abstract: Chronic wounds such as diabetic foot ulcers, venous ulcers, and pressure ulcers are a major source of morbidity and mortality. To describe wound characteristics associated with a wound emergency, the Wound Electronic Medical Records (WEMR) of 200 consecutive admissions (139 patients, average number of admissions 1.4) to a dedicated inpatient wound healing unit over a period of 5 months were retrospectively reviewed. Patient mean age was 62 +/- 16 years, 59% were men, 27% had a foot ulcer and diabetes mellitus, and 29% had venous ulcers. Presenting signs and symptoms included wound pain, cellulitis, nonpurulent drainage, and undermining, but few presented with classic local clinical signs of infection. Treatment consisted of sharp debridement with deep tissue culture and pathology from the wound base and/or systemic antibiotics. Twenty-percent (20%) of patients had pathology-confirmed and 38% had pathology- or radiology-confirmed osteomyelitis on admission, supporting that new or increasing wound pain, cellulitis, and/or nonpurulent drainage or presence of significant undermining may be indicative of an invasive infection and that patients presenting with these signs and symptoms require an immediate treatment plan and consideration of hospital admission. Use of an objective documentation system such as the WEMR may help alert clinicians to subtle wound changes that require aggressive treatment; thereby, avoiding emergency room visits and hospital admissions. Future research is needed utilizing the WEMR across multiple medical centers to further define criteria for a chronic wound emergency.
authors.affiliation: Helen & Martin Kimmel Wound Center, Department of Surgery, New York University School of Medicine, 301 East 17th Street, New York, NY 10003, USA. Harold.brem@nyumc.org
authors.forename: Michael S
authors.initials: MS
authors.lastname: Golinko
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Robert
authors.initials: R
authors.lastname: Rennert
authors.forename: Anna
authors.initials: A
authors.lastname: Flattau
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
authors.forename: Harold
authors.initials: H
authors.lastname: Brem
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004282:Documentation / Q000379:methods*; D042241:Early Diagnosis; D057286:Electronic Health Records / Q000458:organization & administration*; D004630:Emergencies / Q000451:nursing*; D005260:Female; D006757:Hospital Units; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment / Q000458:organization & administration*; D012189:Retrospective Studies; D017592:Skin Care / Q000379:methods / Q000451:nursing; D013997:Time Factors; D014945:Wound Healing; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*