NTR1849 (http://www.trialregister.nl).

For some wound care interventions, robust evidence exists upon which clinical decisions should be based.

Significance: Large variation and many controversies exist regarding the treatment of, and care for, acute wounds, especially regarding wound cleansing, pain relief, dressing choice, patient instructions, and organizational aspects. Recent Advances: A multidisciplinary team developed evidence-based guidelines for the Netherlands using the AGREE-II and GRADE instruments. A working group, consisting of 17 representatives from all professional societies involved in wound care, tackled five controversial issues in acute-wound care, as provided by any caregiver throughout the whole chain of care. Critical Issues: The guidelines contain 38 recommendations, based on best available evidence, additional expert considerations, and patient experiences. In summary, primarily closed wounds need no cleansing; acute open wounds are best cleansed with lukewarm (drinkable) water; apply the WHO pain ladder to choose analgesics against continuous wound pain; use lidocaine or prilocaine infiltration anesthesia for wound manipulations or closure; primarily closed wounds may not require coverage with a dressing; use simple dressings for open wounds; and give your patient clear instructions about how to handle the wound. Future Directions: These evidence-based guidelines on acute wound care may help achieve a more uniform policy to treat acute wounds in all settings and an improved effectiveness and quality of wound care. SCOPE AND SIGNIFICANCEFor chronic wounds, such as venous, arterial, pressure, and diabetic foot ulcers, several (inter)national guidelines are available. 1 For wounds with an acute etiology, fewer guidelines exist. Still, an undesirable inconsistency in wound care practice is evident from the huge number of wound dressings available, the large number of caregivers involved, and the many opinions regarding optimum wound care. 2 This calls for more evidence-based and more uniform care to avoid undesired variation in care. TRANSLATIONAL RELEVANCEIn terms of translational research, available guidelines have focused on diminishing barriers for wound healing given certain comorbid conditions, 3 or have described inconsistencies in the documentation of surgical wound care according to existing guidelines, mainly regarding the prevention and treatment of surgical site infections, which hamper interdisciplinary communication. 4 CLINICAL RELEVANCECurrent clinical guidelines on acute wound care comprise the CDC

In wound care research, available high-level evidence according to the evidence pyramid is rare, and is threatened by a poor study design and reporting. Without comprehensive and transparent reporting, readers will not be able to assess the strengths and limitations of the research performed. Randomized clinical trials (RCTs) are universally acknowledged as the study design of choice for comparing treatment effects. To give high-level evidence the appreciation it deserves in wound care, we propose a step-by-step reporting standard for comprehensive and transparent reporting of RCTs in wound care. Critical reporting issues (e.g., wound care terminology, blinding, predefined outcome measures, and a priori sample size calculation) and wound-specific barriers (e.g., large diversity of etiologies and comorbidities of patients with wounds) that may prevent uniform implementation of reporting standards in wound care research are addressed in this article. The proposed reporting standards can be used as guidance for authors who write their RCT, as well as for peer reviewers of journals. Endorsement and application of these reporting standards may help achieve a higher standard of evidence and allow meta-analysis of reported wound care data. The ultimate goal is to help wound care professionals make better decisions for their patients in clinical practice.In the present era of evidence-based medicine, the use of best available evidence has become an essential part of clinical decision making to ensure and improve quality of care. The requirements to meet this hunger for evidence are the following: first, a proper design and conduct of studies rendering convincing evidence, and second a clear and concise, but at the same time comprehensive and unbiased, description of the conducted research to show the validity of the study and the effect of the intervention investigated.In wound care research, available high-level evidence according to the evidence pyramid 1 is rare, and is threatened by either a poor study design or inconclusive results. [2][3][4][5][6] Nevertheless, the number of scientific publications in wound care shows a 30-fold increase over the last five decades. 7During this period, numerous guidelines and recommendations have been developed to improve the quality of design and conduct of wound care research. 3,5,8 Unfortunately, upgrading the quality of a study design does not automatically improve the quality of reporting in wound care publications. 4,9-11 First, positive study results tend to be published more often than indifferent or negative study results, known as publication bias. Second, adverse events may be neglected or reported selectively (also known as reporting bias, caused by the researchers). Third, the nomenclature of essential terms or presentation of the results may differ from other publications in similar areas.6,12-15 These sources of bias emphasize the need for full and transparent reporting of wound care research, which will allow readers to assess the strengths and limitations o...

The care for chronic and acute wounds is a substantial problem around the world. This has led to a plethora of products to accelerate healing. Unfortunately, the quality of studies evaluating the efficacy of such wound care products is frequently low. Randomized clinical trials are universally acknowledged as the study design of choice for comparing treatment effects, as they eliminate several sources of bias. We propose a framework for the design and conduct of future randomized clinical trials that will offer strong scientific evidence for the effectiveness of wound care interventions. While randomization is a necessary feature of a robust comparative study, it is not sufficient to ensure a study at low risk of bias. Randomized clinical trials should also ensure adequate allocation concealment and blinding of outcome assessors, apply intention-to-treat analysis, and use patient-oriented outcomes. This article proposes strategies for improving the evidence base for wound care decision making.