Therapeutic Index for Local Infections score validity: a retrospective European analysis

Abstract

Objective: A score to identify local wound infections was developed by a panel of experts from seven European countries. The Therapeutic Index for Local Infections (TILI) score was designed for health professionals who are not specialised in wound care. This study was carried out to test the validity of the TILI score in everyday practice. Method: Content validity was analysed by means of evaluation by a panel of experts, individually and face-to-face, followed by a European multicentred, retrospective, observational study. Participating clinicians sent anonymised copies of completed TILI scores for patients with leg ulcers along with a photograph of the wound for analysis by two blinded reviewers. Concordance (Kappa index) and convergent criterion validity (sensitivity, specificity, accuracy, Youden's J Index and receiver operator characteristic (ROC) or area under the curve (AUC) curve) were calculated to construct validity and reliability. Results: A total of 307 patients with leg ulcers from seven institutions in five European countries were included in this retrospective analysis. It was shown that the diagnosis of local wound infection could be documented well with five of the six clinical criteria included in the TILI score. By summing up these facultative criteria in comparison with any direct criteria that may be present, there would have been an indication for local antiseptic wound therapy in 22% of patients examined. Conclusions: The results show that the TILI score is concordant with the expert assessment of patients and with good diagnostic characteristics. Thus, the easy-to-use TILI score can now be used in the daily routine practice of health professionals to diagnose local wound infections.

Postoperative Wundinfektionen

“…Aktuelle Beispiele hierfür sind der "Surgical Site Infection Risk Score" (SSIRS [41]), der W.A.R-Score ("Wounds-at-risk" [10,21]) oder der TILI-Score("Therapeutischer Index für lokaleInfektionen" [11,12]),welcheverschiedenen Aspekten der Früherkennung dienen: -Der SSIRS (. Tab.…”

Moisture‐associated skin damage (MASD): A best practice recommendation from Wund‐D.A.CH.

“…Feces contain a large amount of bacteria and fungi [6], and if the skin barrier is compromised, skin contact may result in frequent bacterial and/or fungal superinfections. This should be differentiated from primary infections such as tinea corporis, erythrasma, or impetigo contagiosa.…”

“…Short‐term use of topical glucocorticoids may be useful in cases of severe eczema if monitored by a dermatologist. In cases of localized infection or high risk, antimicrobial or antifungal treatments may be indicated after appropriate diagnostics [6]. Although moist wound healing is preferred in many other cases [33], it is important for MASD patients to eliminate any excessively moist, pathophysiologically relevant (wound) conditions.…”

Flüssigkeits‐assoziierte Hautschäden (FAH): Eine Best Practice Empfehlung von Wund‐D.A.CH

“…Bei Kontakt von Stuhl mit der Hautoberfläche kommt es zu einer hohen Last an Bakterien und Pilzen [6]. Bei vorgeschädigter Hautbarriere resultieren dann gehäuft bakterielle und/oder mykotische Superinfektionen.…”

“…Die kurzzeitige Anwendung topischer Glukokortikoide kann bei ausgeprägten Ekzemen unter dermatologischer Kontrolle sinnvoll sein. Bei Vorliegen einer lokalen Infektion oder einem hohen Infektionsrisiko sollte nach entsprechender Diagnostik antimikrobiell beziehungsweise antimykotisch behandelt werden [6]. Im Gegensatz zu der ansonsten propagierten feuchten Wundversorgung [33] ist es bei Patienten mit FAH wichtig, das übermäßig feuchte, pathophysiologisch relevante (Wund‐)Milieu zu beseitigen.…”