Clinical Characteristics Of 317 Inpatients With Chronic Wound

ObjectiveTo investigate the trend of disease spectrum of chronic wound in recent 20 years,analyze the clinical characteristics of inpatients with chronic wound,and provide theoretical basis for the correct,reasonable and effective treatment for patients with chronic wound.MethodsA descriptive study combining retrospective data with literature survey data.Collect the 317 inpatients with chronic wounds who were discharged from a general Hospital graded 3A in Guangdong Province from January 1st to December 31 st in 2018.Look up their medical records and analyze the demography,etiology,comorbidity,characteristics of ulcer,laboratory and chemical examination,treatment,bacterial etiology,treatment outcome and health economics of these patients.Results1.In this study,317 patients with chronic wounds were collected,including 190 males and 127 females.The age of the patients was 3 years old at the minimum and 99 years old at the maximum,and the high-incidence age group was 61-80 years old(47.0%).The proportion of retired patients took the lead(39.1%),followed by unemployed patients(25.9%)and manual labor patients(24.0%).Most of the patients had middle school education(47.0%)and primary school education(35.5%).2.Among the causes of wound formation,pressure(26.5%)and diabetes(24.3%)accounted for the majority,followed by trauma(18.0%)and infection(16.1%).The pressure sore was mainly formed outside the hospital(70.2%).The number of male patients with pressure ulcer was significantly higher than that of female patients(P < 0.05).The wounds were mainly distributed in the lower extremities(62.3%)and sacrococcygeal(18.1%).Most patients had one wound(83.0%),followed by two wounds(13.6%).Eleven patients had three or more wounds,of which 10 were male and 1 was female.3.There were 132 patients who had been diagnosed with diabetes,only 35 of whom with normal fasting blood glucose.The Hba1 c of 66 patients with diabetes history was elevated than that of normal,and Hba1 c was higher than 9.0% in 27 patients of whom.Fasting blood glucose was higher than normal in 36 patients with previously undiagnosed diabetes.In all cases recorded,138 patients were submitted for bacteria culture tests,among which 117 patients' wounds secretions were cultured positive with the positive rate of 84.8%.As for the proportion of pathogens,Gram-negative(G-)bacteria accounted for 50.9%(82),and Staphylococcus aureus and Escherichia coli were the most common pathogens.There were 290 patients treated with antibiotics.Cephalosporins were the most frequently used(246/317,77.6%),and the use of penicillins(25.2%),nitromidazoles(24.3%)and quinolones(24.0%)followed.4.After hospitalization,135 patients had their wounds basically healed(42.6%),49 patients showed little signs of improving(15.5%),23 patients underwent amputation surgery as a consequence(7.3%),and another 30 patients ultimately passed away(9.5%).The complete healing rate of infective and traumatic wounds was 74.5% and 61.4%.23 patients with pressure sore died and the amputation rate of diabetic wound was 19.5%.A total of 203 patients underwent vacuum-assisted closure(64.0%).The healing rate of patients with vacuum-assisted closure was significantly higher than those of patients without it(p<0.01).5.The average duration of hospitalization was 37.71 days,and the average cost per patient was 98,148.1 RMB.Hospitalization fee paid by social insurance accounted for the majority(216/317,68.1%),while 77 people paid by themselves(24.3%).On average,61.0% of total expenses were for treatment,20.5% for drugs,7.8% for laboratory tests,6.5% for surgery and 2.4% for nursing.Conclusions:1.In 2018,the majority of patients hospitalized in a general Hospital graded 3A in Guangdong Province due to chronic wounds were male,with 61-80-year-old as the high incidence age group.The proportion of middle school educated patients took the lead.The main causes of wound were pressure sore and diabetes,and pressure sore was mainly formed outside the hospital.The chronic wound caused by gout was a regional characteristic of the chronic wound in Guangdong Province.Most of the wounds occurred in the lower extremity and sacrococcygeal region.2.Most of the patients with diabetes did not control their blood glucose effectively,and some of them did not diagnose diabetes until they were admitted to hospital.The main pathogens of wound infection were Gram-negative bacteria,and Staphylococcus aureus had the highest detection rate.Antibiotics were widely used in the treatment of chronic wounds.3.Different etiology and whether vacuum-assisted closure was used,the prognosis of wound was also different.The use of VAC could significantly improve the wound healing.Chronic wound healing caused by trauma and infection was the best,the mortality of patients with pressure sore was the highest,and the amputation rate of wound caused by diabetes was the highest.4.Hospitalization expenses are mainly paid by social basic medical insurance,followed by self-expense.Among them,the treatment cost accounts for the highest proportion,followed by drugs,and nursing cost accounts for the lowest proportion.The average hospitalization days of patients with chronic wound were significantly increased.