Definition of a checklist
- A checklist is a simple, practical, rapid tool, for a thorough, safe and efficient assessment.
- It is not an algorithm nor a guideline.
- There are several wound assessment tools with indeterminate or inadequate ratings and based on low to very low evidence, but there are few checklists for assessing a patient with a lower leg ulcer (LLU).
- It can help the clinician in the systematic assessment and appropriate management plan of a patient with a LLU
Checklist for comprehensive assessment of a patient with a lower leg ulcer
For a holistic and systematic assessment of a patient with a LLU, the following elements should be checked:
Patient history
Clinical assessment
Further procedures
Treatment plan
Table 11 from EWMA document: Lower Leg Ulcer Diagnosis and Principles of Treatment
The mnemonic rule of the three Is for assessing, diagnosing and referring patients (3I, ADP, PPL)
Identify
- assess the patient’s history (Insulin for diabetes?) and symptoms and perform a thorough status (Ischemia? Infection?)
Investigate:
- Vascular assessment is crucial (pulses, ABI).
- Atypical wounds, Distension, oedema and Pressure ulcers (ADP) should be considered for differential diagnosis
Implement:
- Appropriate Local treatment plan, including Periwound skin care and compression therapy, considering Patient reported outcomes
- Refer the patient to a specialist if needed (e. g., revascularisation, endovenous treatment…)
The EWMA one-pager: Assessment, Diagnosis and Referral Pathway for Patients with Lower Leg Ulcers aims to be a practical tool to aid for the diagnosis of a lower leg ulcer, focusing on the diagnostics of infection, arterial and venous insufficiency, leg oedema and atypical causes.
