Department of Surgery, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Department of Emergency Medicine, Radboudumc, 6500 HB, Nijmegen, The Netherlands.
Sci Rep. 2022 Jun 14;12(1):9901. doi: 10.1038/s41598-022-13221-1.
Annually, a vast number of patients visits the emergency department for acute wounds. Many wound classification systems exist, but often these were not originally designed for acute wounds. This study aimed to assess the most frequently used classifications for acute wounds in the Netherlands and the interobserver variability of the Gustilo Anderson wound classification (GAWC) and Red Cross wound classification (RCWC) in acute wounds. This multicentre cross-sectional survey study employed an online oral questionnaire. We contacted emergency physicians from eleven hospitals in the south-eastern part of the Netherlands and identified the currently applied classifications. Participants classified ten fictitious wounds by applying the GAWC and RCWC. Afterwards, they rated the user-friendliness of these classifications. We examined the interobserver variability of both classifications using a Fleiss' kappa analysis, with a subdivision in RCWC grades and types representing wound severity and injured tissue structures. The study included twenty emergency physicians from eight hospitals. Fifty percent of the participants reported using a classification for acute wounds, mostly the GAWC. The interobserver variability of the GAWC (κ = 0.46; 95% CI 0.44-0.49) and RCWC grades (κ = 0.56; 95% CI 0.53-0.59) was moderate, and it was good for the RCWC types (κ = 0.69; 95% CI 0.66-0.73). Participants considered both classifications helpful for acute wound assessment when the emergency physician was less experienced, despite a moderate user-friendliness. The GAWC was only of additional value in wounds with fractures, whereas the RCWC's additional value in acute wound assessment was independent of the presence of a fracture. Emergency physicians are reserved to use a classification for acute wound assessment. The interobserver variability of the GAWC and RCWC in acute wounds is promising, and both classifications are easy to apply. However, their user-friendliness is moderate. It is recommended to apply the GAWC to acute wounds with underlying fractures and the RCWC to major traumatic injuries. Awareness should be raised of existing wound classifications, specifically among less experienced healthcare professionals.
每年，都有大量患者前往急诊室治疗急性伤口。存在许多伤口分类系统，但这些系统往往并非最初为急性伤口设计。本研究旨在评估荷兰最常使用的急性伤口分类方法，以及 Gustilo Anderson 伤口分类（GAWC）和红十字会伤口分类（RCWC）在急性伤口中的观察者间变异性。这是一项多中心横断面调查研究，采用在线口头问卷形式。我们联系了荷兰东南部 11 家医院的急诊医师，并确定了目前使用的分类方法。参与者应用 GAWC 和 RCWC 对 10 个虚构伤口进行分类。之后，他们对这些分类方法的易用性进行了评分。我们使用 Fleiss' kappa 分析评估了这两种分类方法的观察者间变异性，将 RCWC 等级和类型细分，代表伤口严重程度和受伤组织结构。研究纳入了来自 8 家医院的 20 名急诊医师。50%的参与者报告使用了急性伤口分类方法，其中大多数使用 GAWC。GAWC 的观察者间变异性（κ=0.46；95%CI 0.44-0.49）和 RCWC 等级（κ=0.56；95%CI 0.53-0.59）为中等，RCWC 类型的观察者间变异性良好（κ=0.69；95%CI 0.66-0.73）。尽管易用性中等，但参与者认为在经验不足的急诊医师进行急性伤口评估时，这两种分类方法都有助于评估。GAWC 仅在存在骨折的伤口中具有附加价值，而 RCWC 在急性伤口评估中的附加价值独立于骨折的存在。急诊医师在评估急性伤口时保留使用分类方法。GAWC 和 RCWC 在急性伤口中的观察者间变异性很有前景，并且两种分类方法都易于应用。但是，它们的易用性中等。建议在存在骨折的急性伤口中应用 GAWC，在严重创伤性损伤中应用 RCWC。应提高对现有伤口分类方法的认识，特别是在经验不足的医疗保健专业人员中。
