Which venous leg ulcers will heal with limb compression bandages?

• Published in: The American journal of medicine Vol. 109; no. 1; pp. 15 - 19
• Main Authors: Margolis, David J, Berlin, Jesse A, Strom, Brian L
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2000; Elsevier; Elsevier Sequoia S.A
• Subjects: Aged; Bandages; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Chronic Disease; Cohort Studies; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Humans; Legs; Male; Medical sciences; Middle Aged; Patients; Predictions; Prognosis; Retrospective Studies; ROC Curve; Ulcers; Varicose Ulcer - pathology; Varicose Ulcer - therapy; Wound Healing; Skin disease; Prognosis; Size; Lower limb; Duration; Compressive bandage; Leg; Treatment; Evolution; Ulcer; Predictive factor; Vein; Cicatrization
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/S0002-9343(00)00379-X

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 cm 2 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.