Abstract
PURPOSE: To develop a simple prediction rule to identify patients in whom a venous
leg ulcer will heal using a limb compression bandage (eg, Unna’s boot).
SUBJECTS AND METHODS: We performed a retrospective cohort study of patients with venous
leg ulcers who received a limb compression bandage applied weekly. Prognostic factors
were assessed from the patient’s history before the start of treatment. The outcome
of interest was a healed wound within 24 weeks of treatment. The final model was validated
in another data set.
RESULTS: Several accurate prognostic models were developed. The simplest model summed
the size and duration of the wound before treatment, with 1 point given for a wound
with an area >5 cm2 and another if the wound was >6 months old. In the development data set, ulcers healed
in 93% (110 of 118) of patients with a score of 0, but in only 13% (9 of 67) of those
with a score of 2. In the validation data set, ulcers healed in 95% (19 of 20) of
patients with a score of 0, and 37% (44 of 120) of those with a score of 2.
CONCLUSIONS: This simple prognostic model can be used to discriminate between patients
with a venous leg ulcer that will or will not heal within 24 weeks of care with a
limb compression bandage. The model may be useful in determining which patients to
treat with a limb compression, and which patients should be referred or considered
for alternative treatments.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Venous thromboembolism and other venous disease in the Tecumseh community health study.Circulation. 1973; 48: 839-846
- Chronic ulcer of the leg.BMJ Clin Res Ed. 1987; 294: 1389-1391
- Epidemiology of varicose veins.Br J Surg. 1994; 81: 167-173
- Leg ulcer epidemiology.Acta Chir Scand. 1988; 544: 17-20
- Diagnosis and classification of chronic wounds.Clin Dermatol. 1994; 12: 3-11
- Chronic cutaneous ulcers.J Invest Dermatol. 1994; 102: 38S-41S
- Management of chronic venous leg ulcers.Clin Dermatol. 1994; 12: 19-26
- A systematic review of compression treatment for venous leg ulcers.BMJ. 1997; 315: 576-580
- Rapid healing of venous ulcers and lack of clinical rejection with an allogeneic cultured human skin equivalent. Human Skin Equivalent Investigators Group.Arch Dermatol. 1998; 134: 293-300
- Drug treatment of chronic venous insufficiency and venous ulceration.J Roy Soc Med. 1991; 84: 354-358
- A prospective, randomized trial of Unna’s boots versus hydroactive dressing in the treatment of venous stasis ulcers.J Vasc Surg. 1988; 7: 478-483
- A randomized trial comparing cadexomer iodine and standard treatment in the out-patient management of chronic venous ulcers.Br J Dermatol. 1983; 109: 77-83
- A prospective, randomized trial of Unna’s boot versus Duoderm CGF hydroactive dressing plus compression in the management of venous leg ulcers.J Vasc Surg. 1992; 15: 480-486
- Edema control in the management of disabling chronic venous insufficiency.Arch Phys Med Rehabil. 1991; 75: 436-441
- Unna’s boot vs. polyurethane foam dressings for the treatment of venous ulceration.Arch Surg. 1990; 125: 489-490
- Comparison of two occlusive bandages in the treatment of venous leg ulcers.Br J Dermatol. 1986; 114: 227-230
- Lothian and Forth Valley leg ulcer healing trial. Part 1. Elastic versus non-elastic bandaging in the treatment of chronic leg ulceration.Phlebology. 1992; 7: 130-141
- A cost analysis for the treatment of patients with venous ulceration.Wounds. 1994; 4: 138-141
- Randomised, double blind placebo controlled trial of pentoxifylline in the treatment of venous leg ulcers.BMJ. 1999; 319: 875-878
- Clinical evaluation of recombinant human platelet-derived growth factor for the treatment of lower extremity diabetic ulcers. Diabetic Ulcer Study Group.J Vasc Surg. 1995; 21: 71-78
- Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (becaplermin) in patients with chronic neuropathic diabetic ulcers.Diabetes Care. 1998; 21: 822-827
- The treatment of lower extremity venous ulceration.Hosp Pract. 1992; 27: 32-44
- Risk factors associated with the failure of a venous leg ulcer to heal.Arch Dermatol. 1999; 135: 920-926
- Planimetric rate of healing in venous ulcers of the leg treated with pressure bandage and hydrocolloid dressing.J Am Acad Dermatol. 1993; 28: 418-421
- Definitions and guideline for assessment of wounds and evaluation of healing.Arch Dermatol. 1994; 130: 489-493
- Reliability and validity of the clinical interpretation of a healed chronic wound.Wound Rep Reg. 1996; 4: 335-338
- Measuring the accuracy of diagnostic systems.Science. 1988; 240: 1285-1293
- Signal Detection Theory and ROC Analysis in Psychology and Diagnostics. 1st ed. Lawrence Erlbaum Associates, Mahwah, NJ1996: 1-308
- Effect of changing patient mix on the performance of an intensive care unit severity-of-illness model.Crit Care Med. 1996; 24: 1968-1973
- Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy.Stat Sci. 1986; 1: 54-77
- A leisurely look at the bootstrap, the jackknife, and cross-validation.Am Statistician. 1983; 37: 36-48
Hosmer DW, Lemeshaw S. Goodness of fit tests for multiple logistic regression model. Commun Statist Part A Theoret Math. 1980;A9:1043–1069.
- Venous leg ulcers.BMJ. 1992; 305: 1119-1121
- Factors associated with healing leg ulceration with high compression.Age Aging. 1995; 24: 407-410
- Venous leg ulcers.Br J Dermatol. 1993; 129: 270-274
- The clinical usefulness of wound healing rates.Ostomy/Wound Manage. 1994; 40: 20-24
- The influence of wound geometry on the measurement of wound healing rates in clinical trials.J Vasc Surg. 1996; 23: 524-528
- Efficacy and prognostic value of simple wound measurements.Arch Dermatol. 1999; 134: 1571-1574
- Pressure Ulcers in Adults. Prediction and Prevention. Agency for Health Care Policy and Research, Rockville, MD1992: 1-63
- Leg ulcers.J Am Acad Dermatol. 1991; 25: 965-987
- A comparison of sensitivity analyses of the effect of wound duration on wound healing.J Clin Epidemiol. 1999; 52: 123-128
- Diagnosis of chronic venous disease of the lower extremities.Mayo Clin Proc. 1996; 71: 338-345
- Assessing the generalizability of prognostic information.Ann Intern Med. 1999; 130: 515-524
- Clinical Trials A Methodologic Perspective. John Wiley & Sons, New York1997: 1-590
Article Info
Publication History
Published online: August 16, 2004
Accepted:
March 20,
2000
Received in revised form:
March 20,
2000
Received:
September 27,
1999
Footnotes
☆Supported in part by a Career Development award from the Dermatology Foundation and Grant AG 00715 from the National Institutes of Health.
Identification
Copyright
© 2000 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
