The evolution of a hospital based leg ulcer clinic

The objective was to determine whether there was a change over time in referral patterns, as well as clinical and demographic features, of patients attending a hospital based outpatient leg ulcer clinic based at a tertiary referral hospital servicing a total population of 473,500. This prospective clinical audit involved the collection of comprehensive clinical data of all patients referred to the ulcer clinic over an 8 year study period.

The referral source, patients’ demographic and clinical features, as well as the type of management instituted were recorded. Six hundred and twenty seven patients attended the clinic. The mean age of patients at admission was 72.3 years. General practitioners (GPs) referred approximately 80% of these patients and there was no significant change in patients’ demographic features.

Over time, there was a statistically significant increase in the number of patients who presented with an ulcer which had been present for less than 3 months and there was a significant decrease in the proportion of subjects who presented with multiple ulcers. The proportion of venous ulcers treated at the clinic decreased from 53.7% during the first two year period to 35.9% in the final two year period, whilst there was a 6% increase in the proportion of ulcers caused by combined arteriovenous insufficiency over this time. In conclusion, although there was only minimal change in patients’ demographic features or referral source, there was a significant change in the clinical features of patients over time.