Evidence-Based Chronic Ulcer Care And Lower Limb Outcomes Among Pacific Northwest Veterans

ASU Author/Contributor (non-ASU co-authors, if there are any, appear on document)
Erin Bouldin, Assistant Professor, PhD (Creator)
Appalachian State University (ASU )
Web Site: https://library.appstate.edu/

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.

Additional Information

Karavan, M. , Olerud, J. , Bouldin, E. , Taylor, L. and Reiber, G. E. (2015). Evidence-based chronic ulcer care and lower limb outcomes among Pacific Northwest veterans. Wound Rep and Reg, 23: 745-752. doi:10.1111/wrr.12341. Publisher version of record available at: https://onlinelibrary.wiley.com/doi/10.1111/wrr.12341
Language: English
Date: 2015
evidence-based care, ulcer, lower limb, veterans

Email this document to