UHMS Members Verify Reliability of Wound Score Tool

  • Renée Duncan, Communications Coordinator, Undersea and Hyperbaric Medical Society
  • Volume 07 - Issue 3

Updated assessment scoring improves upon existing systems.


(Based on communications with Dr. Michael Strauss and from the paper “Reliability assessment of an innovative wound score,” by Michael B. Strauss, MD; Hojin Moon, PhD; Jeremy A Busch, DPM; Christopher K. Jones, DPM; Lisa Nhan, DPM; Stuart Miller, MD; Phi-Nga Jeannie Le, MD; Wounds 2016: 28(6); 206-213)


UHMS member Dr. Michael Strauss and his colleagues at Long Beach Memorial Medical Center in Long Beach, California, are no strangers to the war on wounds. Their latest campaign is an updated assessment system developed by taking the best points of several other wound scoring systems and adding features they note will help better define scoring.

Its name: the [Long Beach] Wound Score, or [LB]WS. “The [LB]WS is the first wound scoring system that has reliability and validation data to support its use,” Strauss said in an email communication to the UHMS.

Strauss and colleagues have published a paper that describes the new system: “Reliability assessment of an innovative wound score,” which appeared in the June 2016 issue of Wounds (Wounds 2016; 28(6):206-213). A subsequent article in progress will deal with the validation — i.e., outcome predictions — of the [LB]WS.

A number of wound scoring systems have been devised over the years to evaluate and treat wounds. The [LB]WS system operates before, during and after treatment and helps evaluate effectiveness of protocols in wound therapy.

The [LB]WS utilizes important features of existing systems, including the following:

  • the Wagner grade for perfusion assessment
  • the National Pressure Ulcer Advisory Panel (NPUAP) for depth assessment
  • the University of Texas Health Science Center San Antonio Diabetic Wound Classification (UTDWC) for perfusion and infection plus depth assessments (which utilizes important components of the other three systems)
  • the Infectious Disease Society of America (IDSA) Clinical Classification of a Diabetic Foot Infection for infection assessment

The [LB]WS system integrates their most important features and adds two extra parameters. In addition to assessment by depth, degree of infection and perfusion, the [LB]WS adds assessment of wound size and appearance of the wound base to the essential features of the four existing systems. In addition, it grades each assessment on a continuum of severity.

Of the 14 UHMS approved indications for the use of hyperbaric oxygen therapy, wounds have a starring role in the number of ailments in that list. Wounds cover a lot of territory because they play a large part in the development and subsequent treatment of indications such as gas gangrene, crush injury, compartment syndrome, arterial insufficiencies, compromised grafts and flaps, and intracranial abscesses.
Problem wounds — those that just don’t heal as expected — represent a growing and significant challenge to our health care system. So it makes sense that new tools in the war against wounds are being developed and refined, particularly when it’s done by health-care professionals who know the beneficial effects of hyperbaric oxygen in dealing with hard-to-heal wounds.

Whereas the older systems are devoted mainly to evaluating diabetic foot ulcer (DFU), the [LB]WS is applicable for non- DFU as well as for those with diabetes who have wounds located in areas other than in the foot.

“The [LB]WS could be a very useful tool for wound management with respect to comparative effectiveness research (CER) — comparing treatment interventions for ‘like-for like’ wounds — and meaningful clinically important improvement, or MCII,” Strauss noted.

“We hope we can begin to answer vital questions as to whether the intervention truly changes the clinical course,” he said. “This has very important ramifications, especially for selection of wound dressing agents as well as hyperbaric oxygen usage.”

Reprinted with permission from the Summer 2016 issue of  Pressure, the newsletter of the UHMS; www.uhms.org/ publications/pressure.html.

About the Contributor


MICHAEL STRAUSS, M.D., an orthopaedic surgeon, is the retired medical director of the Hyperbaric Medicine Program at Long Beach Memorial Medical Center in Long Beach, California. He continues to be clinically active in the program and focuses his orthopaedic surgical

practice on evaluation, management and prevention of challenging wounds. Dr. Strauss is a clinical professor of orthopaedic surgery at the University of California, Irvine, and the orthopaedic consultant for the Prevention- Amputation Veterans Everywhere (PAVE) Problem Wound Clinic at the VA Medical Center, Long Beach, California. He is well known to the readers of WCHM from his multiple articles related to wounds and diving medicine published in previous editions of the journal. In addition, he has authored two highly acclaimed texts, Diving Science and MasterMinding Wounds.



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