The Need for an Intersociety Consensus Guideline for Venous Ulcer

Abstract

Due to their recurrence and prolonged healing time, venous ulcers (VU) consume considerable resources in healthcare systems–up to 1% of healthcare budgets in some industrialized countries. Best practice guidelines (GLs) incorporate evidence-based diagnostic and therapeutic recommendations in a cost-effective manner and have been associated with improved and effective outcomes for many diseases (eg, deep vein thrombosis/pulmonary embolism). In order to develop a more universal GL we determined whether there are common elements in GLs for venous ulcers and their evidentiary strength. A systematic analysis of GLs for venous ulcers that were identified through http://clinicaltrials.gov, a government-sponsored Web site, and from experts outside the US. Ten of 12 GL on venous ulcers (seven from North America and five from Europe) were evidence-based, with the majority using the GRADE method. Only two had been developed or updated within the last 3 years. Venous duplex and ankle-brachial index were recommended in all. Debridement was suggested in two, while simple nonadherent wound dressings were favored in nine, and hydrocolloid in two. Only one GL discussed a range of dressing options, dependent on the condition of the venous ulcers. High-pressure multi-layer compression bandages were favored in 10. Only two focused on the importance of improving ankle joint mobility. While there are numerous evidence-based GLs for venous ulcers, the majority may lag recent developments in the field. There is agreement on two elements–dressings and compression, among the various GLs, which should facilitate the development of a consensus GL, similar to that for deep vein thrombosis/pulmonary embolism. To improve patient care and reduce wasted resources, it is imperative for specialty societies to join together and develop this consensus document.