Clear Decision Criteria Are Lacking
The guideline presented by the authors meets the formal criteria of the S3 level. The main messages, however, are based on a consensus, which reflects more closely the character of an S1 guideline. So what validity does this guideline have? This is not so much a question for the authors but for the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) itself. What kind of sense does a guideline make at an S3 level, if of 4998 literature citations analyzed, only 38 randomized controlled trials meet the criteria? Does the AWMF have mechanisms in place that stipulate a certain quantity of evidence as the basis for developing an S3 guideline, or does S3 refer mainly to the guideline’s genesis but states nothing about the meaningfulness of its content?
The lack of evidence means that clear criteria for decision making are lacking in the guideline. Regarding wound care products, it says that in existing studies, none of the investigated materials (alginate, foams, acrylate, hydrocolloid, hydrofiber dressings, moist dressings, gauze) were found to have any advantage over other materials for wound healing. In selecting the materials the following criteria should have priority, in accordance with the patient’s objectives and the requirements of the wound and economicalness: avoidance of pain, practicality for the patient, condition of wound margin and environment, adhesive strength, absorption and retention of exudate, allergies, and tolerability (expert consensus).
The statement that an advantage was not found for any of the materials under investigation leads to a situation where no one can advise against any of the materials, and the doctor/nurse with wound expertise has to make the selection themselves. In sum, the S3 guideline puts its trust into the qualifications and experience of the wound expert. This underlines the importance of qualified wound experts, whose education is an important aim of the “Chronische Wunden e. V. [chronic wounds reg assoc]” initiative.
Prof. Dr. med. Knut Kröger
Klinik für Gefäßmedizin
HELIOS Klinikum Krefeld GmbH, Krefeld
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Rüttermann M, Maier-Hasselmann A, Nink-Grebe B, Burckhardt M: Local treatment of chronic wounds in patients with peripheral vascular disease, chronic venous insufficiency and diabetes. Dtsch Arztebl Int 2013; 110(3): 25–31. VOLLTEXT|