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      Prognostic factors for delayed healing of complex wounds in adults: A scoping review

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          Abstract

          Complex or hard‐to‐heal wounds continue to be a challenge because of the negative impact they have on patients, caregivers, and all the associated costs. This study aimed to identify prognostic factors for the delayed healing of complex wounds. Five databases and grey literature were the sources used to research adults with pressure ulcers/injuries, venous leg ulcers, critical limb‐threatening ischaemia, or diabetic foot ulcers and report the prognostic factors for delayed healing in all care settings. In the last 5 years, a total of 42 original peer‐reviewed articles were deemed eligible for this scoping review that followed the JBI recommendations and checklist PRISMA‐ScR. The most frequent prognostic factors found with statistical significance coinciding with various wound aetiologies were: gender (male), renal disease, diabetes, peripheral arterial disease, the decline in activities of daily life, wound duration, wound area, wound location, high‐stage WIfI classification, gangrene, infection, previous ulcers, and low ankle brachial index. It will be essential to apply critical appraisal tools and assessment risk of bias to the included studies, making it possible to make recommendations for clinical practice and build prognostic models. Future studies are recommended because the potential for healing through identification of prognostic factors can be determined, thus allowing an appropriate therapeutic plan to be developed.

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          Most cited references72

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          PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation

          Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.
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            Updated methodological guidance for the conduct of scoping reviews

            The objective of this paper is to describe the updated methodological guidance for conducting a JBI scoping review, with a focus on new updates to the approach and development of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (the PRISMA-ScR).
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              The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI).

              Critical limb ischemia, first defined in 1982, was intended to delineate a subgroup of patients with a threatened lower extremity primarily because of chronic ischemia. It was the intent of the original authors that patients with diabetes be excluded or analyzed separately. The Fontaine and Rutherford Systems have been used to classify risk of amputation and likelihood of benefit from revascularization by subcategorizing patients into two groups: ischemic rest pain and tissue loss. Due to demographic shifts over the last 40 years, especially a dramatic rise in the incidence of diabetes mellitus and rapidly expanding techniques of revascularization, it has become increasingly difficult to perform meaningful outcomes analysis for patients with threatened limbs using these existing classification systems. Particularly in patients with diabetes, limb threat is part of a broad disease spectrum. Perfusion is only one determinant of outcome; wound extent and the presence and severity of infection also greatly impact the threat to a limb. Therefore, the Society for Vascular Surgery Lower Extremity Guidelines Committee undertook the task of creating a new classification of the threatened lower extremity that reflects these important considerations. We term this new framework, the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System. Risk stratification is based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging, but heterogeneous population.
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                Author and article information

                Contributors
                s-raquelmarquessilva@ucp.pt
                Journal
                Int Wound J
                Int Wound J
                10.1111/(ISSN)1742-481X
                IWJ
                International Wound Journal
                Blackwell Publishing Ltd (Oxford, UK )
                1742-4801
                1742-481X
                14 March 2023
                September 2023
                : 20
                : 7 ( doiID: 10.1111/iwj.v20.7 )
                : 2869-2886
                Affiliations
                [ 1 ] Centre for Interdisciplinary Research in Health, Instituto de Ciências da Saúde Universidade Católica Portuguesa Porto Portugal
                [ 2 ] School of Nursing Department Universidade Federal Ceará Fortaleza Brazil
                [ 3 ] Unidade de Saúde Familiar Corino de Andrade Porto Portugal
                [ 4 ] School of Nursing Department Universidade Católica Portuguesa Porto Portugal
                Author notes
                [*] [* ] Correspondence

                Raquel Marques, Centre for Interdisciplinary Research in Health, Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Porto, Portugal.

                Email: s-raquelmarquessilva@ 123456ucp.pt

                Author information
                https://orcid.org/0000-0002-6701-3530
                https://orcid.org/0000-0001-5867-8023
                https://orcid.org/0000-0002-3293-9325
                https://orcid.org/0000-0002-5330-779X
                https://orcid.org/0000-0002-6348-3316
                Article
                IWJ14128
                10.1111/iwj.14128
                10410354
                36916415
                89995220-ee94-4224-aea5-423c897988eb
                © 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 08 February 2023
                : 12 January 2023
                : 13 February 2023
                Page count
                Figures: 1, Tables: 8, Pages: 18, Words: 9791
                Funding
                Funded by: Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa , doi 10.13039/501100005856;
                Award ID: UIDB/04279/2020
                Categories
                Review Article
                Review Articles
                Custom metadata
                2.0
                September 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.2 mode:remove_FC converted:09.08.2023

                Emergency medicine & Trauma
                decision making,prognosis,wound healing,wounds and injuries
                Emergency medicine & Trauma
                decision making, prognosis, wound healing, wounds and injuries

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