Brookshier Trent, Swoboda Laura, Rogers Chrystalbelle
Podiatry, North Park Podiatry, San Diego, USA.
Translational Science, Carthage College, Kenosha, USA.
Cureus. 2025 Aug 4;17(8):e89352. doi: 10.7759/cureus.89352. eCollection 2025 Aug.
The escalating prevalence and incidence of individuals with chronic, non-healing, or hard-to-heal wounds is staggering and poses significant financial burdens on the healthcare system. Initial wound evaluations and assessments are often performed first by urgent care, emergency responders, or even general medicine professionals who are skilled practitioners but are not chronic wound specialists and may have only received a limited amount of education or training specific to wound care. As a result, these medical providers may not be familiar with current wound care scoring systems that aid in determining wound severity, guiding early interventions, and identifying the need for specialized care based on patients' overall medical condition and wound status. A referral to a wound care specialist has the potential to expedite healing, reduce the overall cost of care, alleviate patient suffering, and ultimately, save a limb or a life. The blood flow, infection, offloading, metabolic issues, and exudate, social (BIOMES℠) tool is a coined acronym that can be used by any healthcare provider to quickly identify whether a patient should be referred to a specialist by classifying a wound as low, moderate, or high risk for delayed healing. Blood flow, infection/bioburden, offloading/overloading, metabolic/morbidity, exudate/edema, and social/economic barriers are assessed, and 1 point is assigned to each barrier that can be identified as a red flag with the potential to affect the healing trajectory of a patient's wound. Wounds are classified as follows: low risk: no barriers; moderate risk: 1 BIOMES℠ barrier; high risk: 2 or more BIOMES℠ barriers. Any patient identified as moderate or high risk should be referred to a wound care specialist in hopes that earlier, more aggressive wound care and medical management will result in improved wound healing versus traditional wound management. Addressing these barriers is essential for wound management and improved outcomes, especially in lower extremity care.
慢性、难愈合或难以治愈伤口患者的患病率和发病率不断攀升，令人震惊，并给医疗系统带来了巨大的经济负担。伤口的初步评估通常首先由紧急护理人员、急救人员甚至普通内科医生进行，他们虽然都是技术娴熟的从业者，但并非慢性伤口专家，可能仅接受过有限的伤口护理专项教育或培训。因此，这些医疗服务提供者可能并不熟悉当前用于确定伤口严重程度、指导早期干预以及根据患者整体病情和伤口状况确定是否需要专科护理的伤口护理评分系统。转诊至伤口护理专家有可能加快伤口愈合、降低总体护理成本、减轻患者痛苦，并最终挽救肢体或生命。血流、感染、减压、代谢问题和渗出液、社会（BIOMES℠）工具是一个首字母缩写词，任何医疗服务提供者都可以使用它，通过将伤口分类为低、中、高延迟愈合风险，快速确定患者是否应转诊至专科医生。对血流、感染/生物负荷、减压/过载、代谢/发病率、渗出液/水肿以及社会/经济障碍进行评估，对于每一个可被识别为可能影响患者伤口愈合轨迹的危险信号的障碍，给予1分。伤口分类如下：低风险：无障碍；中度风险：1个BIOMES℠障碍；高风险：2个或更多BIOMES℠障碍。任何被确定为中度或高风险的患者都应转诊至伤口护理专家，以期早期、更积极的伤口护理和医疗管理能够比传统伤口管理带来更好的伤口愈合效果。解决这些障碍对于伤口管理和改善治疗效果至关重要，尤其是在下肢护理方面。
