Table 3.
Reviewed studies focused on clinical signs and symptoms of chronic wound infection
| Items | Bowler et al46 | Danielsen et al49 | Gardner, Frantz & Doebbeling32 | Tudor50 | Vowden & Vowden51 | Woo & Sibbald36 | Dennis et al44 | Fierheller & Sibbald47 | Cutting et al8 | Rondas et al48 | Rondas et al45 |
| Study design | Descriptive‐cross‐sectional study | Case study | Cross‐sectional study | Case study | cross‐sectional study | Cross‐sectional study | Cross‐sectional study | Cross‐sectional study | Delphi approach | Cross‐sectional study | multi‐centred cross‐sectional study |
| Sample size/number of CLUs | 71 CLUS | 1 VLU | 36 CWs/7 VLUs | 1 MLU | 482 LUs/269 CLUs | 112 CWs/35 CLUs | 203 CLUs | 40 CLUs | 21 experts | 211 CWs/34 CLUs | 72 CWs/4.8% CLUs |
| Level of evidence | III‐2 | IV | III‐2 | IV | IV | III‐2 | III‐2 | II | III‐1 | III‐3 | |
| Overall comment | malodour resulted from microbial synergy | ulcer enlargement related to infection | could not confirm the reliability of the CSSC | increased wound pain related to infection | erythema, smell, and pus were most frequently reported signs | 4 combined signs had sensitivity of 91.6% heavy bacterial growth | CSSC: no clear structure, not a valid tool to measure infection in leg ulcers | increased peri‐wound skin temperature significantly related to wound infection | a causal relationship between wound infection and the occurrence of pain | no significant relationship between clinical & microbial assessments | increased exudate, erythema, and pain were diagnostic signs of infection |
| Increased ulcer pain | – | N/A | Spec 100% | Yes | – | – | – | – | Yes | – | 56.3% |
| Malodour | Yes | N/A | Spec 88% | Yes | Yes | Spec 86% | Yes | Sens 100% | N/A | – | – |
| Increased wound size | N/A | Yes | N/A | N/A | – | Spec 83% | N/A | N/A | N/A | N/A | N/A |
| Purulent exudate | – | N/A | – | Yes | Yes | N/A | Yes | Sens 87% | N/A | – | – |
| Wound breakdown | N/A | N/A | Spec 100% | Yes | – | Spec 89% | Yes | Sens 100% | N/A | N/A | N/A |
| Delayed/non‐healing | N/A | N/A | Sens 81% | N/A | – | – | Yes | Spec 86% | N/A | – | – |
| Increased exudate levels | N/A | N/A | – | – | – | – | – | Sens 100% | N/A | – | 68.8% |
| Erythema | – | N/A | – | Yes | Yes | Sens 87% | – | Spec 92% | N/A | – | 81.3% |
| Bridging of the epithelium | N/A | N/A | N/A | N/A | – | N/A | N/A | N/A | N/A | – | N/A |
| Pocketing at wound base | N/A | N/A | – | N/A | – | N/A | – | Sens 100% | N/A | – | N/A |
| Discoloured granulation | N/A | N/A | – | Yes | – | N/A | – | Sens 93% | N/A | – | N/A |
| Friable granulation | N/A | N/A | Sens 82% | Yes | – | – | – | – | N/A | N/A | – |
| Increased local temperature | – | N/A | Spec 84% | Yes | – |
Spec 71% Sens 76% |
– | Spec 86%–>2FΔ | N/A | – | – |
| Oedema | – | N/A | – | Yes | – | – | N/A | – | N/A | – | – |
| Cellulitis | – | – | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Abscess | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Slough or necrotic tissue | N/A | N/A | N/A | Yes | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| Induration | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | – | – |
CLUs, chronic leg ulcers; CSSC, clinical signs and symptoms check list; CWs, chronic wounds; LUs, leg ulcers; MLUs, mixed leg ulcers; N/A, not applicable; Sens, sensitivity; Spec, specificity; VLUs, venous leg ulcers.