Assessment of chronic wounds in adults: an integrative review

Samaniego-Ruiz, María-Jesús; Llatas, Federico Palomar; Jiménez, Onofre Sanmartín

doi:10.1590/S1980-220X2016050903315

Brasil

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Review Article • Rev. esc. enferm. USP 52 • 2018 • https://doi.org/10.1590/S1980-220X2016050903315 linkcopy

Assessment of chronic wounds in adults: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: To identify the main aspects that should be assessed in adults with chronic wounds.

Method: This was an integrative review of the scientific literature published between 2010 and early 2015 in the PubMed and Web of Science databases.

Results: Few studies exclusively address wound assessment. However, the review found many aspects to consider when assessing individuals with ulcers, grouped as follows: factors that significantly affect healing or the development of new wounds (age, nutritional status, functional capacity, or comorbidities), pyschosocial factors, and wound characteristics (location, size, depth, type of tissue, time of evolution).

Conclusion: The literature search did not result in any one aspect that must be considered when assessing chronic wounds, but a complex interaction of factors that include both physiological and social and psychological elements. Professionals should be aware of this multifactorial approach to achieve early detection of the development and evolution of ulcers and to intervene accordingly.

DESCRIPTORS
Ulcer; Wounds and Injuries; Wound Healing; Risk Factors; Nursing Assessment; Review

Author	Year	Main objective	Results/Conclusions
Lizaka⁽¹⁰⁾	2010	To investigate the impact of the nutritional status of home care patients with Pus	Malnutrition was associated with the development of PUs.
Takahashi⁽¹¹⁾	2011	To determine risk factors for future PUs.	Age and comorbid medical conditions.
Bergquist⁽¹²⁾	2011	To identify risk factors for developing PUs at home.	Incontinence, level of dependency, and prior presence of PUs.
Michel⁽¹³⁾	2012	To identify the predicting factors of PUs.	Immobility and malnutrition
Coleman⁽¹⁴⁾	2013	To identify independent predicting risk factors of PU.	There is a complex interaction among different factors.
Joseph⁽¹⁵⁾	2013	To explore the literature about the use of tools by nurses to assess risk and identify patients at greater risk to develop PUs.	Assessment must be a combination of knowledge, clinical judgment and scales.
McGinnis⁽¹⁶⁾	2013	To identify the characteristics of patients and ulcers associated with healing of heel PUs.	Increased severity of ulcer and presence of peripheral arterial disease were related to poor prognosis.
García⁽¹⁷⁾	2014	To determine the capacity of risk assessment scales and clinical judgment of nurses to predict development of PUs.	Assessment must take into account clinical judgment and the use of validated scales.
Alex⁽¹⁸⁾	2010	To examine the risk factors for ulcers on patients with diabetes mellitus.	Insulin therapy, peripheral neuropathy, age, gender, callosity, deformities and ulcers.
Ikem⁽¹⁹⁾	2010	To assess the risk factors associated with diabetic foot ulcers.	Patients presented risk factors for peripheral arterial disease, their diagnosis could be made using a handheld Doppler.
Altenburg⁽²⁰⁾	2011	To characterize the bio-psycho-social factors associated with the development of diabetic foot ulcers.	Patients with diabetic foot tend to present less conscientious health behaviors.
Apelqvist⁽²¹⁾	2011	To identify factors related to healing among patients with diabetic foot ulcers and peripheral vascular disease.	Comorbidity, extent of affected tissue and severity of peripheral vascular disease.
Monteiro⁽²²⁾	2012	To identify studies about factors associated with diabetic foot.	Neuropathy, peripheral vascular disease, foot deformity and prior ulcers or amputation.
Moura Neto⁽²³⁾	2013	To determine the epidemiological presentation of diabetic foot and understand whether there are easily assessed variables capable of predicting the development of the diabetic foot.	Predictors of diabetic foot were being male and the presence of neuropathy. The combination of neuropathy and peripheral vascular disease significantly increased risk of amputation.
Pickwell⁽²⁴⁾	2013	To assess the influence of ulcer location (diabetic foot).	Worse results found for heel ulcers, followed by midfoot and toe ulcers.
Baba⁽²⁵⁾	2014	To determine the prevalence and associated factors of foot ulcers among community-based patients with type 2 diabetes.	Peripheral sensitive neuropathy was a significant risk factor. However, peripheral arterial disease was also an important independent contributing factor.
Siersma⁽²⁶⁾	2014	To identify factors responsible for low health-related quality of life associated with foot ulcers and the relative importance of these factors.	Treatment requires a multifactorial approach, going beyond just healing ulcers.
Iversem⁽²⁷⁾	2015	To prospectively examine whether depressive symptoms increase risk of diabetes and diabetic foot ulcers.	Depressive symptoms were associated with a higher risk of ulcers.
Fawzy⁽²⁸⁾	2014	To study the relationship between plantar pressure and neuropathy with or without ulceration.	Individuals with diabetes that presented neuropathy and/or ulcers presented elevated plantar pressure.
Nehring⁽²⁹⁾	2014	To compare risk factors for diabetic foot among the population with type 2 diabetes and risk factors for diabetes among healthy individuals.	Patients who were inclined to develop diabetic foot presented different risk factors than the patients who were at risk for diabetes.
Moffatt⁽³⁰⁾	2010	To determine factors associated with healing among patients with chronic leg ulcers of any type.	Duration of ulcer, deep vein thrombosis and absence of infection.
Dinh⁽³¹⁾	2012	Hypothesis: changes in the peripheral nerve function and the diabetes-associated proinflammatory state are related not only to the development of diabetic foot but with wound-healing failure.	Increased inflammation, expression of matrix metalloproteinase-9 and serum levels of fibroblast growth factor were associated with non-healing.
Gil⁽³²⁾	2015	Hypothesis: there is an underlying malignancy that could explain the chronic and non-healing nature of wounds.	The prevalence of malignancy may be greater than expected, thus it should be assessed through a biopsy.
Abolfotoub⁽³³⁾	2011	To identify risk factors for diabetic foot among diabetic patients.	Duration of diabetes, neuropathy, level of erythrocyte sedimentation rate.
Nehring⁽³⁴⁾	2015	To identify risk factors of diabetic foot of neuropathic origin occurrence in patients with type 2 diabetes.	Male gender, duration of diabetes, height, weight, and waist circumference.
Parker⁽³⁵⁾	2015	To review the available evidence on risk factors for delayed healing of venous leg ulcers.	Larger ulcer area and longer ulcer duration, previous ulcers, venous abnormalities and lack of high compression.
Francia⁽³⁶⁾	2015	To assess how ankle joint mobility can be useful in the identification of patients with diabetes at risk of foot ulcers.	The evaluation of ankle joint mobility can indicate which foot is at higher ulcer risk.
St-Supery⁽³⁷⁾	2011	To identify existing methodologies available for wound healing assessment in clinical and research settings.	At the moment of the study, no ideal methodology was found.
Scotton⁽³⁸⁾	2014	To identify clinical and therapeutic factors that influence healing of venous ulcers.	Longstanding ulcer, infection, lack of compression and longer use of antibiotics.
Beckman⁽³⁹⁾	2014	To identify the association between incontinence-associated dermatitis, its most important etiologic factors, and PUs.	There was an association between incontinence, its etiologic factors, and PUs.

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[TFN2] Note: n=30