Algorithm for triage of chronic wounds

PA: physician's assistant; ABI: ankle-brachial index; MRI: magnetic resonance imaging; WIfI: Wound, Ischemia, foot Infection classification; PUSH: pressure ulcer scale for healing; CEAP: Clinical-Etiology-Anatomy-Pathophysiology classification.
* Wound scoring systems (eg, WIfI for chronic limb-threatening ischemia, PUSH for pressure-induced injury, CEAP for venous ulceration) can help determine increasing wound severity that may indicate need for higher level care setting.
¶ Home health and telehealth services may include a phone call, use of telehealth platform (computer, smartphone), or an in-person nursing/physician assistant service with telehealth communication with a physician. These require an appropriate level of wound care that can be administered in the proposed setting, phone access, and social support, and may require internet access to transmit images or other data.
Δ Follow-up is often at weekly intervals, although depending on wound etiology, more or less frequent follow-up may be needed, particularly during the early course of treatment.
◊ May include obtaining imaging studies (eg, plain radiography, magnetic resonance imaging, ultrasound) to evaluate for deep space infection, osteomyelitis, or arterial occlusion.
§ There is no specific timeframe that defines the transition from an acute (ie, healing) wound to a chronic (ie, stagnant) wound. Some suggest that lack of approximately 15% reduction weekly or approximately 50% reduction of the surface area of the wound over a one-month period indicates a chronic state. Re-evaluation of wound etiology, particularly presence of ischemia, is important.