title: Clinical wound assessment using DESIGN-R total score can predict pressure ulcer healing: pooled analysis from two multicenter cohort studies.
abstract: There are few clinical tools with both predictive validity for pressure ulcer healing and availability in broad populations. We evaluated whether the total scores from DESIGN-R tool could predict pressure ulcer healing. We followed 3,196 patients with pressure ulcers from two multicenter cohort studies until wound healing, patient death, or discharge. Wound severity was evaluated by DESIGN-R tool from 0 (healed) to 66 (greatest severity). In the multivariate Cox proportional hazard model, higher DESIGN-R total scores at baseline were associated with lower healing rates (hazard ratio 0.90, 95% confidence interval 0.89-0.92), independent of the patient's characteristics, setting types, and wound depth or location. DESIGN-R had discriminative value for wound healing up to 90 days; the area under the receiver-operating characteristics curve from univariate analysis was 0.81 for healing within 30 days and 0.74 for healing within 30-90 days. The cutoff points were 9 for healing within 30 days and 18 within 30-90 days (positive and negative predictive value 78.8 and 74.1%; 63.9 and 81.1%, respectively). These points were validated for both superficial and deep ulcers. DESIGN-R can be a useful tool to predict pressure ulcer healing for a wide range of patient populations, settings, and wound locations.
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. hsanada-tky@umin.ac.jp
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sanada
authors.forename: Shinji
authors.initials: S
authors.lastname: Iizaka
authors.forename: Yuko
authors.initials: Y
authors.lastname: Matsui
authors.forename: Masutaka
authors.initials: M
authors.lastname: Furue
authors.forename: Takao
authors.initials: T
authors.lastname: Tachibana
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakayama
authors.forename: Junko
authors.initials: J
authors.lastname: Sugama
authors.forename: Katsunori
authors.initials: K
authors.lastname: Furuta
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tachi
authors.forename: Keiko
authors.initials: K
authors.lastname: Tokunaga
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Miyachi
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D003668:Pressure Ulcer / Q000145:classification / Q000473:pathology*; D016016:Proportional Hazards Models; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014945:Wound Healing