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Vascular Assessment in Chronic Wound Care:
Affect of HBO2T on Forecasting Patient Outcome
George A Perdrizet, Justin Mohr, Patrick Worth, Caesar Anderson, Brian Solomon, Christine Shapter
University of Connecticut/Hartford Hospital, Hartofrd, CT
Objective: To report our experience using non-invasive vascular studies (transcutaneous oxygen tension, TCpO2 and ankle/brachial index, ABI) for clinical decision making and demonstrate how the use of HBO2 may affect standard algorithms currently in place.
Design/setting/Patients: A clinical series, sequential adult patients presenting to a comprehensive wound care clinic, within a tertiary care hospital, for evaluation and treatment of chronic lower extremity wounds during a 3 year period (8/03-8/06). Patients were selected if they had had TCpO2 and/or ABI as part of their evaluation and had at least a 10 week follow-up period. Data was extracted from patients’ clinical records with IRB approval.
Main Outcome Measure: Wound healing rate at 10 weeks relative to results of vascular evaluation (A-adequate/E-equivocal/I-inadequate). A comparison of data sets was performed using the Fisher Exact test for diachotomous data and Student’s t test for continuous data. Statistical significance was reached if p = 0.05.
Results: A total of 122 adult patients (115 TCpO2 and 51 ABI measurements) experienced a 56% healing rate at 10 weeks. Healing rates stratified by TCpO2 (A/E/I) were 80%, 40%, and 40% respectively (p < 0.05 A vs E/I) . Healing rates stratified by ABI (A/E/I) were 80%, 80% and 20% respectively ( p < 0.05 A/E vs I). The subset of patients with “Inadequate” TCpO2 had a 27% healing rate at 10 weeks compared to 50% had they received HBO2T (p < 0.05).
Conclusions: Techniques of vascular assessment provide a fair estimate of patients who are likely to heal (A/E groups). However patients with studies considered to be inadequate to support wound healing may respond favorably to HBO2T.
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