Evidence-based chronic ulcer care and lower limb outcomes among Pacific Northwest veterans.
Wound Repair Regen
; 23(5): 745-52, 2015 Sep.
Article
em En
| MEDLINE
| ID: mdl-26171654
ABSTRACT
Evidence-based ulcer care guidelines detail optimal components of care for treatment of ulcers of different etiologies. We investigated the impact of providing specific evidence-based ulcer treatment components on healing outcomes for lower limb ulcers (LLU) among veterans in the Pacific Northwest. Components of evidence-based ulcer care for venous, arterial, diabetic foot ulcers/neuropathic ulcers were abstracted from medical records. The outcome was ulcer healing. Our analysis assessed the relationship between evidence-based ulcer care by etiology, components of care provided, and healing, while accounting for veteran characteristics. A minority of veterans in all three ulcer-etiology groups received the recommended components of evidence-based care in at least 80% of visits. The likelihood of healing improved when assessment for edema and infection were performed on at least 80% of visits (hazard ratio [HR] = 3.20, p = 0.009 and HR = 3.54, p = 0.006, respectively) in patients with venous ulcers. There was no significant association between frequency of care components provided and healing among patients with arterial ulcers. Among patients with diabetic/neuropathic ulcers, the chance of healing increased 2.5-fold when debridement was performed at 80% of visits (p = 0.03), and doubled when ischemia was assessed at the first visit (p = 0.045). Veterans in the Pacific Northwest did not uniformly receive evidence-based ulcer care. Not all evidence-based ulcer care components were significantly associated with healing. At a minimum, clinicians need to address components of ulcer care associated with improved ulcer healing.
Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Veteranos
/
Cicatrização
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Medicina Baseada em Evidências
/
Desbridamento
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Tratamento de Ferimentos com Pressão Negativa
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Bandagens Compressivas
/
Úlcera da Perna
Tipo de estudo:
Guideline
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
/
Humans
/
Male
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article