The validity of the clinical signs and symptoms used to identify localizedchronic wound infection

It is uncertain how accurately classic signs of acute infection Identify in fection in chronic wounds, or if the signs of infection specific to seconda ry wounds are better indicators of infection in these wounds. The purpose o f this study was to examine the validity of the ''classic" signs (i.e., pai n, erythema, edema, heat, and purulence) and the signs specific to secondar y wounds (i.e serous exudate, delayed healing, discoloration of granulation tissue, friable granulation tissue, pocketing at the base of the,wound, lo ut odor, and wound breakdown). Thirty-six chronic wounds were assessed for these signs and symptoms of infection with interobserver reliability rangin g from 0.53 to 1.00, The wounds were then quantitatively cultured, and 11 ( 31%) were found to be infected, increasing pain, friable granulation tissue , foul odor, and wound breakdown showed validity based on sensitivity, spec ificity, discriminatory power, and positive predictive values. The signs sp ecific to secondary wounds were better indicators of chronic wound infectio n than the classic signs with a mean sensitivity of 0.62 and 0.38, respecti vely. None of the signs or symptoms was a necessary indicator of infection, but increasing pain and wound breakdown were both sufficient indicators wi th specificity of 100%.