Jacqui Fletcher, BSc (Hons), RN.
Senior Lecturer, University of Hertfordshire, HatfieldThe practicalities of monitoring the frequency of chronic wounds were discussed last month (Fletcher, 2003). The aim of this paper is to consider some of the published data currently available and to identify key issues related to this information.
Definitions of prevalence and incidence are given in Box 1.
In most chronic wound literature frequency figures are presented as a percentage occurrence rate. For example, a prevalence rate may be 27%; however, the leg ulcer studies tend to present their data as ratios - a number out of the population. So they would appear as 178:200 000 (Rotchell, 1999), which equates to 0.89%. While this is an interesting observation it actually makes little difference. However, for those who find maths challenging it is simply another hurdle to leap in interpreting and comparing figures. On a positive point, however, it emphasises the size (which is in this case comparatively large) of the total population surveyed and this may not be clear where percentages alone are presented.
It would appear that collecting frequency data on chronic wounds occurs for a variety of reasons and the reason will impact on what is collected and how it is used. Broadly speaking the main reasons appear to be:
As a starting point it is suggested that both authors and journal editors (including reviewers) ensure that adequate definition is given of:
AGREE Collaboration. (2001) AGREE Instrument. Available at: www.agreecollaboration.org Accessed March 2003.
Baumgarten, M. (1998) Designing prevalence and incidence studies. Advances in Wound Care 11: 6, 287-293.
Begg, C., Cho, M., Eastwood, S. et al. (1996) Improving the quality of reporting of randomized controlled trials: the CONSORT statement. Journal of the American Medical Association 276: 8, 637-639.
Bours, G.J.J.W., Halfens, R.J.G., Lubbers, M., Haalboom, J.R.E. (1999) The development of a national registration form to measure the prevalence of pressure ulcers in the Netherlands. Ostomy/Wound Management 45: 11, 28-40.
Chambers. (2003) Chambers Dictionary. London: Harrop Ltd.
Clark, M., Bours, G., Defloor, T. (2002) Summary report on the prevalence of pressure ulcers. EPUAP Review 4: 2, 49-57.
Defloor, T., Bours, G., Schoonhoven, L., Clark, M. (2002) Draft EPUAP statement on prevalence and incidence monitoring. EPUAP Review 4: 1, 13-15.
European Pressure Ulcer Advisory Panel (EPUAP). (2000) Developing a minimum common data set to record the prevalence of pressure ulcers in European hospitals. EPUAP Review 2: 3, 75-77.
Fairbairn, K. (1993) Towards better care for women: understanding fungating breast lesions. Professional Nurse 9: 3, 204-212.
Fletcher, A. (1996) The epidemiology of leg ulcers. In: Cullum, N., Roe, B. (eds). Leg Ulcers Nursing Management: A research-based guide. London: Bailliere Tindall.
Fletcher, J. (2003) Measuring prevalence and incidence of chronic wounds. Professional Nurse 18: 7, 384-388.
Grocott, P. (1993) Fungating malignant wounds I: an overview and priorities for palliative management. Wound Management 4: 2, S2-S3.
Hagisawa, S., Barbenel, J. (1999) The limits of pressure sore prevention. Journal of the Royal Society of Medicine 92: 576-578.
Hutchinson, A., McIntosh, A., Feder, G. et al. (2000) Clinical Guidelines and Evidence Review for Type 2 Diabetes: Prevention and management of foot problems. London: Royal College of General Practitioners.
Kaltenthaler, E., Whitfield, M.D., Walters, S.J. et al. (2001) UK, USA and Canada: how do their pressure ulcer prevalence and incidence data compare? Journal of Wound Care 10: 1, 530-535.
Rotchell, L. (1999) Introducing and auditing a nurse-led leg ulcer service. Professional Nurse 14: 8, 545-550.
Thoroddsen, A. (1999) Pressure sore prevalence: a national survey. Journal of Clinical Nursing 8: 170-179.