The goals of this study were to analyze the 2010 update of the Association for the Advancement of Wound Care (AAWC) Venous Ulcer Guideline (VUG) and examine recommendations with less than A-level evidence to identify important research questions.
The AAWC VUG may be found at http://aawconline.org/professional-resources/resources and at the National Guideline Clearinghouse, http://www.guideline.gov. Supporting references for each recommendation, compiled by the AAWC Guideline Task Force from MEDLINE, CINAHL, and EMBASE databases, may be viewed at the first website.
The literature identified in support of the AAWC VUG recommendations with less than A-level evidence was evaluated and is summarized below.
Questions requiring further research in venous ulcer (VU) care were developed from recommendations having less than A-level support and that fall under the following topics: diagnosis, documentation, prevention, wound care, adjunctive interventions, and palliation.
Practitioners lack strong evidence for several generally accepted recommendations of this synthesis of VU guidelines concerning the following: diagnostic or screening validity of varicosities, timing of biopsies for differential diagnosis, clinic visit frequency, criteria for changing VU care plans, and effective VU preventive parameters. Bedside surgical debridement, several biologic interventions, certain types of grafting, and the comparative efficacy of intravascular surgical procedures also require rigorous examination. Adjunctive interventions to be investigated include systemic pain management, topical biophysical treatments, novel devices, pharmaceuticals, timing, methods and procedures for some surgical interventions.
Better evidence for recommendations with less than A-level support may improve the quality and consistency of VU care, reduce costs, and improve resource use.
The authors analyze the 2010 update of the Association for the Advancement of Wound Care Venous Ulcer Guideline and examine recommendations with less than A-level evidence to identify important research questions.
Laurel M. Morton, MD, is a Resident Physician, Boston University Department of Dermatology, Boston, Massachusetts. Laura L. Bolton, PhD, is an Adjunct Associate Professor, Robert Wood Johnson University Medical School, New Brunswick, New Jersey; President, Bolton SCI LLC, Metuchen, New Jersey; Chief Scientific Advisor, Derma Sciences Inc, Princeton, New Jersey. Lisa Q. Corbett, MSN, APRN, is Team Leader, Hartford Hospital Wound Care and Ostomy Program, and is a member of the Association for the Advancement of Wound Care Guidelines Task Force, North Granby, Connecticut. Susan Girolami, RN, BSN, CWOCN, is the Clinical Director at Therapy Support, Cincinnati, Ohio. Tania J. Phillips, MD, FRCPC, is a Professor of Dermatology, Boston University School of Medicine, Boston, Massachusetts; and Dermatologist, SkinCare Physicians, Chestnut Hill, Massachusetts.
Dr Bolton has disclosed that she holds a current and past position as a consultant/advisor to Derma Sciences, EuroMed, and Systagenix. Ms Girolami has disclosed that she is employed by and has received royalties from Therapy Support for TSI mattress and seating systems.
Dr Morton, Ms Corbett, and Dr Phillips have disclosed they have no financial relationships related to this article.
Submitted October 16, 2012; accepted January 17, 2013.