Clinical predictors of leg ulcer healing

P>Background Identification of factors associated with healing can help in understanding the causes of delayed healing in chronic leg ulceration, and can allow for programmes to be developed to modify these factors to improve patient outcomes. Objectives To determine factors associated with healing in patients with chronic leg ulceration of all types within a defined patient population. Methods The patients were identified within the combined acute/community leg ulcer service within Wandsworth Primary Care Trust. All identified patients agreed to be interviewed and those who were able underwent clinical and noninvasive testing to determine the cause of the ulceration. Follow ups were to a maximum of 48 weeks, with time to healing given as the principal outcome measure. Analysis was by the Cox proportional hazards model for both univariate and multivariate analysis. Results were expressed as hazard ratio with 95% confidence intervals derived from the models. Results In total, 113 patients took part in this study. Univariate analysis revealed statistically significant differences for delayed healing according to the ulcer duration (P = 0 center dot 002), complexity of the ulcer aetiology (P = 0 center dot 035), presence of lipodermatosclerosis (P = 0 center dot 02), history of deep vein thrombosis (DVT) (P = 0 center dot 03) and thrombophlebitis (P = 0 center dot 03). Multivariate analysis showed that ulcer duration (P = 0 center dot 014), DVT (P = 0 center dot 008) and a lack of Pseudomonas on wound swab (P = 0 center dot 005) were independently associated with delayed healing. Conclusions The results indicate the complexity of determining risk factors for poor healing in patients with chronic leg ulceration. There appears to be little scope for interventions to improve healing from the factors identified.