Authors: Michael B. Strauss, MD., Igor V. Aksenov, MD, PhD
Title: A Critical Appraisal of Wound Scoring Systems and the Derivation of a New Paradigm for Wound Evaluations
Addresses: Department of Hyperbaric Medicine, Long Beach Memorial Medical Center, Long Beach, CA. 90801 and University of Florida, Gainesville, FL. 32606
Purpose: To critically appraise the merits and weaknesses of seven different wound scoring systems to establish what are the essential parameters for wound grading and from this information generate the Wound Score, a new paradigm for wound evaluations.
Methods: Seven different wound scoring systems (Forrest Knighton, Lavery, Pecorraro, Pressure Score PUSH and Wagner) were evaluated for components, criteria for scoring, ability to measure progress, objectivity, validity (kappa values) and reliability. From this information the most important parameters for wound evaluation were determined and simple objective ways to measure these criteria were established.
Results: Five parameters: 1) Appearance 2) Size 3) Depth 4) Infection and 5) Perfusion were determined to be the most important for comprehensively evaluating a wound. By scoring each parameter from two (best possible situation) to 0 (worst possible situation) on a non-continuous scale using objective findings, a ten-point scale results. The wound score, tested on 50 patients had a kappa value of 0.8 (with 1.0 being best and
-1.0 being worst). The wound score had high validity in predicting outcomes with a positive predictive value of 0.93 in a series of 63 patients.
Discussion: The Wound Score corrects the deficiencies found in seven published wound scoring systems. Wounds scores in the upper third (7-10) will heal with minimal interventions. Wound scores in the middle third (4-7) will heal with comprehensive management while scores in the lower third (0-3) dictate that lower limb amputations be done.
Significance:The Wound Score provides the means for making objective decisions about wound management and measuring the progress of healing. Accepted evidenced based techniques using validity and reliability measures (which are characteristically lacking in other scoring systems) prove the merits of the Wound Score as a paradigm for wound evaluations