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Chronic nonhealing wounds have a prevalence of 2% in the United States, and cost an estimated $50 billion annually. Accurate stratification of wounds for risk of slow healing may help guide treatment and referral decisions. We have applied modern machine learning methods and feature engineering to develop a predictive model for delayed wound healing that uses information collected during routine care in outpatient wound care centers. Patient and wound data was collected at 68 outpatient wound care centers operated by Healogics Inc. in 26 states between 2009 and 2013. The dataset included basic demographic information on 59,953 patients, as well as both quantitative and categorical information on 180,696 wounds. Wounds were split into training and test sets by randomly assigning patients to training and test sets. Wounds were considered delayed with respect to healing time if they took more than 15 weeks to heal after presentation at a wound care center. Eleven percent of wounds in this dataset met this criterion. Prognostic models were developed on training data available in the first week of care to predict delayed healing wounds. A held out subset of the training set was used for model selection, and the final model was evaluated on the test set to evaluate discriminative power and calibration. The model achieved an area under the curve of 0.842 (95% confidence interval 0.834–0.847) for the delayed healing outcome and a Brier reliability score of 0.00018. Early, accurate prediction of delayed healing wounds can improve patient care by allowing clinicians to increase the aggressiveness of intervention in patients most at risk.

Chronic wounds usually get trapped in the inflammatory stage of wound healing; however, aggressive debridement transforms chronic wounds to acute wounds and therefore complete healing.To investigate healing outcomes and debridement frequency in a large wound data set.Retrospective cohort study.Data collected from 525 wound care centers from June 1, 2008, through June 31, 2012, using a web-based clinical management system.Referred sample of 154 644 patients with 312 744 wounds of all causes (of an initial data set of 364 534 wounds) participated. A total of 47.1% were male. Median age was 69 years (age range, 19-112 years), with 59.2% having one wound. Eligibility criteria included age older than 18 years, receiving at least 1 debridement, and having been discharged from the system. Advanced therapeutic treatment was ineligible. Because of incomplete, questionable, or ineligible data, 57 190 wounds were not included. Most wounds were diabetic foot ulcers (19.0%), venous leg ulcers (26.1%), and pressure ulcers (16.2%).Debridement (removal of necrotic tissue and foreign bodies from the wound) at different frequencies.Wound healing (completely epithelialized with dimensions at 0 × 0 × 0 cm).A total of 70.8% of wounds healed. The median number of debridements was 2 (range, 1-138). Frequent debridement healed more wounds in a shorter time (P .001). In regression analysis, significant variables included male sex, physician category, wound type, increased patient age, and increased wound age, area, and depth. The odds ratio varied considerably for each variable.The more frequent the debridements, the better the healing outcome. Although limited by retrospective data, this study's strength was the analysis of the largest wound data set to date.

There are numerous demands for the limited water supplies in the Rocky Mountain (USA) region, and controversies surrounding instream flows abound. A specific problem involves water diversions (i.e., small dams that shunt water out of stream channels) during the summer irrigation season. We developed an approach to assess the effects of restoration of natural or less-than-natural summer flows on trout that accounts for variation in habitat over long segments of low-gradient, alluvial-valley streams. The approach has utility for managers because it can be conducted with hydologic data, aerial photographs, topographic maps, and a spreadsheet without extensive fieldwork. We applied the approach by assessing the effects of different summer flows on abundance of brown trout ( Salmo trutta) in several streams annually dewatered in the Salt River Valley of western Wyoming. The assessment approach can be calibrated for other trout species and areas of the Rocky Mountain region.