title: A prospective cohort study of prognostic factors for the healing of heel pressure ulcers.
abstract: BACKGROUND
  pressure ulcers, 25-30% of which are on the heels are a major burden to patients and healthcare systems. A better understanding of factors associated with healing is required to inform treatment and research priorities.
  
  
  OBJECTIVE
  to identify patient and pressure ulcer characteristics associated with the healing of heel pressure ulcers.
  
  
  METHODS
  patients with heel pressure ulcers were recruited to a prospective cohort study in a large teaching hospital in the UK, with a maximum 18-month follow-up. Cox proportional hazards model regression analysis was used to identify prognostic factors for healing.
  
  
  RESULTS
  one hundred and forty of 148 patients recruited were analysed. They had 183 pressure ulcers: 77 ulcers healed, 5 were on limbs amputated prior to ulcer healing, 88 were on patients who died prior to healing, 11 were present at the end of the study and 2 were lost to follow-up. The median time to healing was 121 (range 8-440) days. Of 12 variables associated with healing (P ≤ 0.2), multi-variable analysis identified two factors which were independently predictive of healing including the presence of a severe (versus superficial) ulcer (hazard ratio = 0.48, P < 0.1) and the presence of peripheral arterial disease (hazard ratio = 0.40, P < 0.1).
  
  
  CONCLUSIONS
  increased ulcer severity and the presence of peripheral arterial disease significantly reduced the probability of healing. Treatments for heel pressure ulcers should consider the severity of the ulcer and the presence of peripheral arterial disease.
authors.affiliation: Tissue Viability, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary Great George Street, Leeds LS1 3EX, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McGinnis
authors.forename: Darren C
authors.initials: DC
authors.lastname: Greenwood
authors.forename: E Andrea
authors.initials: EA
authors.lastname: Nelson
authors.forename: Jane
authors.initials: J
authors.lastname: Nixon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D005260:Female; D016523:Foot Ulcer / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D003668:Pressure Ulcer / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
keywords: cohort study; heel; older people; pressure ulcer; prognosis; wound healing