Abstract
Healing of non‐traumatic skin ulcers is often suboptimal. Prognostic tools that identify people at high risk of delayed healing within the context of routine ulcer assessments may improve this, but robust evidence on which factors to include is lacking. Therefore, we scoped the literature to identify which potentially prognostic factors may warrant future systematic reviews and meta‐analyses. We conducted electronic searches in MEDLINE and Embase to identify studies in English published between 1997 and 2017 that tested the association between healing of the three most common non‐traumatic skin ulcers encountered by health care professionals (venous leg, diabetic foot, and pressure ulcers) and patient characteristics, ulcer characteristics, and results from clinical investigations. We included 42 studies that investigated factors which may be associated with the healing of venous leg ulcers (n = 17), diabetic foot ulcers (n = 15), and pressure ulcers (n = 10). Across ulcer types, ulcer characteristics were most commonly reported as potential prognostic factors for healing (n = 37), including the size of the ulcer area (n = 29) and ulcer duration at first assessment (n = 16). A total of 35 studies investigated the prognostic value of patient characteristics (n = 35), including age (n = 31), gender (n = 30), diabetes (n = 22), smoking status (n = 15), and history of deep vein thrombosis (DVT) (n = 13). Of these studies, 23 reported results from clinical investigations as potential prognostic factors, with the majority regarding vessel quality. Age, gender, diabetes, smoking status, history of DVT, ulcer area, and ulcer duration at time of first assessment warrant a systematic review and meta‐analysis to quantify their prognostic value for delayed ulcer healing.
Highlights
Foot ulcers in people with diabetes are relatively common, with a total UK point prevalence of 0.1%,2 which amounts to a 5.5% prevalence in the UK diabetic population
A total of 23 studies considered the results of clinical investigations a possible prognostic factor for ulcer healing, with 13 of these concerned the assessments of vessel quality
We included 42 papers, from which we identified age, gender, smoking status, diabetes, musculoskeletal disease, cardiovascular disease, immobility, ulcer area, ulcer location, ulcer duration at time of first assessment, and vessel quality as the factors that were most often investigated as a potential prognostic factor for ulcer healing
Summary
Venous leg ulcers and pressure ulcers are the most common types of complex, non-traumatic skin ulcers, each with an estimated point prevalence of around 0.3% in the United Kingdom and between 0.05% and 1.52% in the United States. Foot ulcers in people with diabetes are relatively common, with a total UK point prevalence of 0.1%,2 which amounts to a 5.5% prevalence in the UK diabetic population. In North America, ulcer prevalence in the diabetic population is estimated to be 13%.3. Available tools only use ulcer characteristics (eg, ulcer size, tissue type) to predict healing time, whereas others require variables that may be difficult to measure as part of regular ulcer assessments in practice (eg, ankle-brachial pressure index).14 To further improve these tools, we need robust evidence on what factors may have prognostic value for assessing the risk of delayed ulcer healing. Parker et al reviewed the literature up to 2013 in order to identify risk factors for delayed venous leg ulcer healing, informing the subsequent development of a prognostic tool.. Parker et al reviewed the literature up to 2013 in order to identify risk factors for delayed venous leg ulcer healing, informing the subsequent development of a prognostic tool.16 They applied a limited set of search terms related to prognostic factors, which was not in line with Cochrane guidance (http:// methods.cochrane.org/prognosis). We expect our findings to guide future decisions about what potential prognostic factors should be prioritised for further investigations through systematic reviews and meta-analyses
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