Tools to Measure Wound Healing

According to Medicare requirements, measurement of wound healing should be performed at least monthly, although best practice dictates that assessment of wound status should be performed weekly or even more frequently.¹

Measurement of Wound Healing

However, despite universal agreement on the importance of regular and frequent measurement of wound healing, there is currently no consensus on the best tool to perform and document wound assessment.  A number of tools for evaluating pressure ulcers have been proposed, including the Bates-Jensen Wound Assessment Tool (BWAT), Pressure Ulcer Scale for Healing (PUSH), Sessing Scale, Sussman Wound Healing Tool (SWHT), Wound Healing Scale (WHS), Photographic Wound Healing Tool (PWHT), and the Japanese Pressure Ulcer Healing Process (PUHP) (Table 1). However, currently only the BWAT, PUSH, and SWHT are widely used in practice.¹

 Bates-Jensen Wound Assessment Tool (BWAT)^1,2

Developed in 1990 and revised in 2001, the BWAT evaluates 13 wound characteristics with a numerical rating scale and rates them from the best to worst. This tool is recommended for assessing and monitoring pressure ulcers and other chronic wounds. It is a paper-based system, and the most widely used of all the wound instruments.

Pressure Ulcer Scale for Healing (PUSH)^1,3

The PUSH, developed in 1997 by the National Pressure Ulcer Advisory Panel, incorporates three wound characteristics: surface area measurement, exudates amount, and surface appearance. PUSH is most effective when used for a heterogenous mixture of wounds to track bioburden as well as healing rate.

 Sussman Wound Healing Tool (SWHT)¹

The SWHT was developed as a diagnostic tool to monitor and track the effectiveness of physical therapy techniques.  SWHT is a qualitative instrument composed of 10 wound attributes combined with nine descriptive attributes of size, extent of tissue damage plus location, and acute wound healing phase.

Table 1.  Comparison of Wound Healing Tools (reproduced from  Sussman 2007¹)

Wound characteristic and format	BWAT	PUSH	Sessing Scale	SWHT	WHS	PWHT	PUHP
Size	X	X		X		X	X
Depth or stage	X		X	X		X	X
Necrotic tissue	X	X	X	X	X	X	X
Granulation tissue	X	X	X	X	X	X	X
Epithelial tissue	X	X	X	X	X	X	X
Surrounding tissue characteristics	X			X		X
Exudate	X	X	X		X	X	X
Undermining and tunnelling	X		X	X	X	X	X
Scoring methods:
Likert scale	X					X	X
Subscales with total score	X	X	X	X			X

 

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References

1. Sussman C and Bates-Jensen B. Wound Care. A collaborative practice manual for health professionals. 3^rd Ed. Wolters Kluwer/Lippincott Williams & Wilkins, Philidelphia, US. 2007.
2. Harris C, Bates-Jensen B, Parslow N, Raizman R, Singh M, Ketchen R. Bates-Jensen wound assessment tool: pictorial guide validation project. J Wound Ostomy Continence Nurs. 2010;37(3):253-9.
3. Günes UY. A prospective study evaluating the Pressure Ulcer Scale for Healing (PUSH Tool) to assess stage II, stage III, and stage IV pressure ulcers. Ostomy Wound Manage. 2009;55(5):48-52.