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Which venous leg ulcers will heal with limb compression bandages?

  • David J Margolis
    Correspondence
    Requests for reprints should be addressed to David J. Margolis, MD, Room 815, Blockley Hall, 423 Guardian Drive; Philadelphia, Pennsylvania 19104
    Affiliations
    Department of Dermatology (DJM), Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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  • Jesse A Berlin
    Affiliations
    Department of Biostatistics and Epidemiology (DJM, JAB, BLS), Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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  • Brian L Strom
    Affiliations
    Department of Biostatistics and Epidemiology (DJM, JAB, BLS), Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

    Department of Medicine (BLS), Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

    Department of Pharmacology (BLS), Center for Clinical Epidemiology and Biostatistics (DJM, JAB, BLS), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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      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.
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