Application of prognostic research to understand and improve complex wound healing outcomes: A narrative review

Wound healing is essential for maintaining the integrity and barrier function of the skin. However, complex or chronic wounds are difficult to treat and are often associated with extended healing times. Increasing prevalence of complex wounds poses a challenge to NHS resources and has a detrimental effect on patients' health-related quality of life. Therefore, it is vital to understand healing complications to optimize complex wound management. Clinical assessment, wound review and biological marker analysis are essential tools that guide prognosis, diagnosis and treatment. This review outlines the value of prognostic factors, models and tools when applied to complex wounds. It explores why prognosis is important to patients and health service providers and considers how understanding of wound healing prognosis may confer patient benefit. Prognostic factors include clinical data such as age, wound characteristics encompassing infection and biological markers such as protease expression. This review highlights some of the limitations of current evidence including issues with study design, methodological quality and considerations for clinical translation into relevant prognostic tools. In future, larger prognostic studies using multivariate analysis methods are essential to consider potential confounding factors. Additional systematic reviews would be valuable to provide a more comprehensive overview of findings and identify areas for improvement. Following published guidelines for prognosis research study design, analysis and reporting would improve research quality. Furthermore, a multifaceted approach to model development which incorporates robustly identified prognostic factors, uses rigorous external validation and considers clinical integration to provide meaningful patient benefit should be adopted in future studies.