Calm, irritated or infected? The experience of the inflammatory states and symptoms of pin site infection and irritation during external fixation: a grounded theory study

Abstract

There is a need for patients and clinicians to be able to differentiate between infected, not infected and irritated pin sites.

Patient-reported symptoms of ‘calm’, ‘irritated’ and ‘infected’ skeletal external fixator pin site wound states; a cross-sectional study

“…The most important symptom of infection, indicated by participants in an earlier study (Santy-Tomlinson et al 2011), was moderate or severe pain, and clinicians involved in the pilot of the questionnaire considered that this would occur in 80% M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 7 of respondents. A minimum sample size of 150 was proposed, which would allow the estimation of this percentage with a 95% confidence interval of +/-6.4%.…”

“…Clint et al (2010) stated that "good" pin sites exhibit no, or minimal, erythema, pain or wound discharge. There is less clinical focus on the calm wound state in comparison to states with more noticeable pain and discomfort but patients use their experience of calm pin sites for comparison in helping them to recognise irritation or infection (Santy-Tomlinson et al 2011).…”

“…The data has, therefore, been treated as within-subjects, repeated measures and quasi-longitudinal. The M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 21 longitudinal approach was largely chosen because an earlier study (Santy-Tomlinson et al 2011) identified that change in the participants' experience of symptoms was an important element in recognising the different clinical states.…”

“…The language employed in the questionnaire was based on common terminology used by participants in a previous qualitative (grounded theory) study (Santy-Tomlinson et al 2011). The terminology used was, therefore, based on English spoken in the United Kingdom.…”

A fresh consensus for pin site care in the UK

“…Large multi-centre trials are needed, but there are numerous variables relating to pin site care and there is no validated outcome measure for pin site infection (Santy, 2010;Santy-Tomlinson et al, 2011). Studies are often methodologically flawed.…”