Moeremans, Paul
Oral Presentation
Research Based
INTRODUCTION: A pretibial wound rarely leads to a thorough clinical examination. Retrospectively new falls, burns, ischaemic attacks, extrasystoles, blocks, car accidents, sudden death and institutionalised care are associated.
MATERIALS AND METHODS: All patients over 60 years with a new pretibial wound of any origin (n=58) , presenting in a family practice were prospectively compared to matched pairs with another wound excluding venous leg ulcers and to matched pairs without wounds. In-depth doctor known medical history, validated word recall and calculation, ECG, carotid ultrasound, arm-ankle pressure index, blood examination, toe oxygen saturation, medication intake compliance were measured.
RESULTS: Odds ratio over 12 for meticulous recall defects of doctor-known medical history. Odds ratio over 8 for skin atrophy, suboptimal weight, frailty, frequent ventricular extrasystoles, burns, peripheral neuropathy, diabetes, renal insufficiency, alcohol abuse, benzodiazepine use. Odds ratio over 5 for impaired recall, logical reasoning, medium term memory deficits, bundle branch blocks, peripheral vascular deficiency, corticosteroid use, occasional major alcohol intake. Odds over 3 for major uncorrected vision disturbances, fractures, beta blocking agents. Patients with burns fit nearly all pretibial wounds odds. Anaemia is associated with all kinds of wounds and with renal insufficiency. Painless wounds have a bad prognosis. Patients with pretibial wounds giving a logical explanation for the fall do not differ from those with a probable central cause. After burns were excluded, matched pairs with other wounds did not differ from controls. Four in ten falls could be prevented.
Topic: Clinical Practice