HMN 2025: How Predictive model of chronic wounds identifies risk factors for amputation and death

Chronic wounds affect thousands of patients each year and can lead to serious complications, including amputation and death. The Regenstrief Institute Chronic Wound Registry, a statewide database that collects real-world clinical data from hospitals and outpatient clinics across Indiana, allows researchers to identify patients at highest risk and generate insights that could help clinicians intervene earlier, improve care and help patients make more informed decisions.

Researchers from Regenstrief, the Indiana University School of Medicine, the University of Utah and other collaborating institutions analyzed data from 52,916 Indiana patients diagnosed with lower extremity chronic wounds between 2011 and 2021. The data, drawn from the Regenstrief Chronic Wound Registry and the Indiana Network for Patient Care (INPC), were used to model how these wounds progress over time.

The paper, “Multistate Model of Chronic Wounds, Amputations, and Mortality,” is published in the journal Annals of Surgery.

Using a multistate model, the study tracked patient transitions from initial diagnosis to minor amputation, major amputation and death. Within three years of wound diagnosis, pooled mortality rates were more than 10% after initial diagnosis, approximately 13% after minor amputation and 19% after major amputation.

The model revealed several key clinical associations. Diabetic foot ulcers were linked to an increased risk of minor amputation, while venous ulcers were associated with lower risks of amputation and death. Pressure ulcers carried a higher risk of death but a lower risk of minor amputation. A history of osteomyelitis was associated with higher amputation risk but lower death risk before major amputation, and sepsis increased the likelihood of death before major amputation.

“The Chronic Wound Registry allows us to take a broad, real-world view of wound care and understand how different types of wounds and complications affect outcomes,” said study senior author Titus Schleyer, DMD, MBA, Ph.D., a Regenstrief research scientist and IU School of Medicine faculty member.

“This work shows how real-world data from multiple health care organizations can be used to understand who is at risk for serious outcomes,” said study lead author Joshua Choi, M.D., M.S., a researcher at the University of Utah and former Regenstrief Clinical Informatics fellow. “Ultimately, we hope this model can support clinicians in making earlier, more proactive decisions to prevent complications.”

The Regenstrief Chronic Wound Registry integrates data from the INPC, which includes health records from more than 18,000 outpatient clinics and more than 90% of hospitals in Indiana. It provides one of the largest and most comprehensive real-world datasets for studying wound care, enabling new insights into disease progression, infection history and treatment outcomes.

Researchers plan to expand the registry to include additional data on wound characteristics, microbiology, therapies, socioeconomic conditions and causes of mortality. Future efforts may use machine learning to extract richer information from clinician notes.

By linking data across health systems, the Regenstrief Chronic Wound Registry provides a powerful foundation for advancing research and improving care for people living with chronic wounds.

The content is provided for information purposes only.