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A prospective case series was studied to assess the potential for complete healing of wounds among patients with advanced illness referred to a regional palliative care program in Toronto, Canada. Two hundred and eighty-two patients, of which 148 were primarily diagnosed with cancer and 134 with non cancer advanced illness, were assessed and followed until their deaths. On the baseline initial referral date, 823 wounds were documented. The wound classes assessed included pressure ulcers, malignant wounds, skin tears, venous leg ulcers, diabetic foot ulcers and arterial leg/foot ulcers. Proportions of patients showing complete healing of at least one wound were calculated, stratified by patient's survival time post-baseline (1 week, 1 month, 3 months and 6 months). Proportions of patients showing complete healing of at least one wound increased the longer patients lived and ranged between 12·9% and 43·5% for stage I pressure ulcers, 0% and 60% for stage II pressure ulcers, 2·4% and 100% for skin tears, 10% and 100% for venous leg ulcers and 0% and 50% for diabetic foot ulcers. Only one person showed complete healing of a stage III pressure ulcer and no complete healing was observed with stage IV pressure ulcers, unstageable pressure ulcers, malignant wounds and arterial leg/foot ulcers., (© 2012 The Authors. © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc.)

Background: Currently available prognostic models for noncancer patients lack high levels of discrimination. Therefore, the quest for additional prognostic factors must continue. To date, none have utilized the occurrence of wounds as a prognostic factor., Methods: As a prospective observational study, based on a sequential case series of 189 advanced noncancer patients, all wounds were documented. One hundred seventy patients were followed until their deaths. Univariate and multivariate survival analyses were performed using hazard ratios (HRs) derived from Cox proportional hazard models., Results: Seventy-eight percent of patients presented with at least one wound at referral. Patients with wounds displayed worse overall survival than those without wounds (p = 0.009). Survival analysis for the full postreferral period revealed a violation of the proportional hazards assumption for pressure ulcers and the Palliative Performance Scale version 2 (PPSv2). In order to address this finding, early deaths (within 14 days of referral) were assessed separately from later deaths (more than 14 days after referral). After controlling for the co-occurrence of wounds, age, gender, Charlson comorbidity index, and PPSv2, pressure ulcers were associated with statistically significant increased risk of death for patients of sufficient health to survive at least 2 weeks after referral (HR 2.42, p = 0.003), while other wounds were associated with greater levels of mortality over the full postreferral period (HR 1.96, p = 0.0001)., Discussion: The occurrence of pressure ulcers and other wounds are correlated with reduced survival in patients with advanced noncancer illness. These data merit incorporation into existing prognostic models or used in conjunction with them to enhance prognostic accuracy.