The ulcerated leg severity assessment score for prediction of venous leg ulcer healing

Article Outline

• Copyright

Conclusion: The Ulcerated Leg Severity Assessment (ULSA) score identifies patients with venous ulcers unlikely to respond to conventional treatment.

Summary: Most, but not all, venous ulcers will heal with compression therapy. The authors sought to develop an assessment score to potentially identify patients whose ulcers would not heal with conventional compression therapy and, therefore, should perhaps be offered alternative therapy for ulcer healing early in their course. Baseline factors affecting venous ulcer healing were assessed in patients with venous ulcers seen between March 1999 and August 2001. All patients were initially treated with multilayer compression therapy. Variables related to 24-week healing were identified, and a Cox regression model was developed to identify risk factors that predicted ulcer healing. From this model, a scoring system was developed and subsequently prospectively validated between February 2004 and March 2005.

The baseline study included 229 patients with venous ulcers. Patient age, ulcer chronicity, and venous refill time (VRT) of ≤20 seconds were identified as risk factors for nonhealing. The authors used these risk factors and hazard ratios from the Cox analysis and derived the following formula: Ulcerated Leg Severity Assessment (ULSA) score = age + chronicity – 50 (when VRT is >20 seconds). Patients with an ULSA score ≤50 had higher 24-week ulcer-healing rates than those with scores >50. This was in both the baseline study (P < .001) and the follow-up prospective validation study performed in 86 patients (P = .007).

Comment: Optimal therapy for venous ulceration continues to be debated. The authors suggest that an elevated ULSA score may indicate patients who early in the course of treatment may benefit from therapies other than compression therapy. Their data, however, shows no benefit with use of these “alternative” therapies. It only identifies individuals who will not do well with compression therapy. It certainly cannot be assumed patients who do not do well with compression therapy will be benefited by alternative therapies. Alternative therapies may also not work well in patients with elevated ULSA scores.