Validation of predictive factors for infection in adults with chronic leg ulcers: A prospective longitudinal study

Management and outcomes among patients with hard-to-heal ulcers in Sweden: a national mapping of data from medical records, focusing on diagnoses, ulcer healing, ulcer treatment time, pain and prescription of analgesics and antibiotics

OBJECTIVE

To investigate whether patients with hard-to-heal ulcers in Sweden were treated according to an aetiological diagnosis and to explore ulcer healing, treatment time, ulcer-related pain and the prescription of analgesics and antibiotics.

DESIGN

A national mapping of data from the patients' medical records, between April 2021 and March 2023.

SETTING

Data from medical records for patients with hard-to-heal ulcers from a randomised clustered sample of two units per level of care and region.

PARTICIPANTS

Patients with hard-to-heal ulcers treated in primary, community and specialist care, public or private, within units covering all 21 regions in Sweden.

OUTCOME MEASURES

Descriptive analysis of data from the patients' medical records.

RESULTS

A total of 2470 patients from 168 units were included, of which 39% were treated in primary care, 24% in community care and 37% in specialist care. A total of 49% of patients were treated without an aetiological diagnosis. Healing occurred in 37% of patients and ulcer-related pain was experienced by 1224 patients (50%). Antibiotics were given to 56% of the patients. Amputation occurred in 5% and 11% were deceased.

CONCLUSION

Only 51% of patients with hard-to-heal ulcers had a documented aetiological ulcer diagnosis, which means that approximately 20 000 patients in Sweden might receive suboptimal treatment. Future research needs to explore why so many patients are undiagnosed and how to improve diagnosis, which could lead to faster healing and shorter treatment times.

Clinical application of polylactic acid/gelatin nanofibre membrane in hard-to-heal lower extremity venous ulcers

Objective:

To evaluate the safety and effectiveness of polylactic acid/gelatin nanofibre membranes (PGNMs) in treating hard-to-heal lower extremity venous ulcer wounds.

Method:

In this prospective study, patients with venous leg ulcers (VLUs) were treated with PGNMs or standard of care. Wounds were assessed once a week until the wound was fully healed.

Results:

The treatment group was comprised of 10 patients with VLUs, aged between 47–64 years, with an average age of 56.58±6.19 years. The wounds were located in the lower leg and/or ankle. Average wound area was 8.91±13.57cm2 (range: 1.5–52.5cm2). Average wound healing time was 18.75±16.36 days. Of the patients, nine (90%) rated their pain as lighter when removing the dressing, with an average pain value of 2.0±1.0 points. There was less secondary trauma to the wound surface, and less bleeding. At six months after the wound healing, the scar evaluation (using the Vancouver Scar Scale) result was 3.75±1.96 points.

Conclusion:

In this study, the PGNMs were safe and effective in treating hard-to-heal lower extremity VLUs.

Antibiotic prescription using a digital decision support system: a register-based study of patients with hard-to-heal ulcers in Sweden

OBJECTIVES

To investigate differences in antibiotic prescription for patients with hard-to-heal ulcers assessed using a digital decision support system (DDSS) compared with those assessed without using a DDSS. A further aim was to examine predictors for antibiotic prescription.

DESIGN

Register-based study.

SETTING

In 2018-2019, healthcare staff in primary, community and specialist care in Sweden tested a DDSS that offers a mobile application for data and photograph transfer to a platform for multidisciplinary consultation and automatic transmission of data to the Registry of Ulcer Treatment (RUT). Register-based data from patients assessed and diagnosed using the DDSS combined with the RUT was compared with register-based data from patients whose assessments were merely registered in the RUT.

PARTICIPANTS

A total of 117 patients assessed using the DDSS combined with the RUT (the study group) were compared with 1784 patients whose assessments were registered in the RUT without using the DDSS (the control group).

PRIMARY AND SECONDARY OUTCOME MEASURES

The differences in antibiotic prescription were analysed using the Pearson's χ² test. A logistic regression analysis was used to check for influencing factors on antibiotic prescription.

RESULTS

Patients assessed using a DDSS in combination with the RUT had significantly lower antibiotic prescription than patients entered in the RUT without using the DDSS (8% vs 26%) (p=0.002) (only healed ulcers included). Predictors for antibiotic prescription were diabetes; long healing time; having an arterial, neuropathic or malignant ulcer.

CONCLUSIONS

A DDSS with data and photograph transfer that enables multidisciplinary communication appears to be a suitable tool to reduce antibiotic prescription for patients with hard-to-heal ulcers.