Archangel calculates a Wound Heal Score based on twelve wound characteristics. The factors include not only the size of the wound but also factors such also changes in the wound bed, exudate amount and much more.
Access the Dashboard on the Archangel Web Application by clicking the dashboard tab on the left-hand menu. You will see the "12-Factor Heal Score" on the dashboard near the top left (see below red box) along with a graph of each wound score for each assessment.
The Heal Score in Archangel is automatically calculated for every assessment using 12 assessment data points and is a key barometer to overall wound health. If the triangle is pointing up and green you know the wound is improving OR if the triangle is pointing down and red you know the wound is deteriorating. The actual score can range from +13 (best score) to -13 (worst score). The more negative the score, the more cause for concern. The 12 factors used to calculate the score are broken down into these 5 categories:
- Wound Measurement
- Wound Bed
- Exudate Amount
- Tunneling and Undermining
- Skin temperature around the wound, wound odor and pain
The 12-Factor Heal Score can also be found on the Archangel mobile application in the list of wounds. The mobile application only displays the "Last Wound Score" for each wound.
Let's look in more detail at each of the 12 factors:
Wound Measurement (3 factors - length, width and depth)
Clinicians measure the length, width and depth of a wound during each assessment. The overall goal is to see wound measurement values decrease over time. A wound is assigned a +1 for each length, width and depth if they are decreasing. If any of these measurements are increasing they are each assigned a -1. No change in measurement is assigned a zero (0).
Wound Bed (3 factors - epithelial, slough and eschar)
When a clinician looks at the amount of Epithelial tissue in a wound from one assessment to the next, the goal is for that amount to increase. An increase is assigned a +1. A decrease in Epithelial tissue is assigned a -1 for that assessment. If there is no change, a score of zero (0) is assigned.
When a clinician looks at the amount of Slough and Eschar in a wound, the less amount the better in the healing process. If that is the case, the wound is assigned +1 for Slough and a +1 for Eschar. If both are increasing as a % of the total wound bed, both are assigned a -1. If neither changes as a % then a zero (0) is assigned for both.
Exudate Amount (1 factor)
Exudate amount is measured from worst to best as (copious, heavy, moderate, light and none). As the amount of exudate decreases a score of +1 is assigned until there is none. If the amount of exudate increases a score of -1 is assigned. No change in exudate amount results in a zero (0) score.
Tunneling and Undermining (2 factors)
A wound with Tunneling is assigned a -1. A wound with Undermining is assigned a -1. A wound with no Tunneling is assigned a +1. A wound with no Undermining is assigned a +1. There is never a zero (0) assigned for these factors.
Wound Area Skin Temperature (1 factor)
When clinicians assess the Wound Temperature and it is normal, the Factor is +1. If it is cold or hot to the touch, a -1 is assigned.
Wound Odor (1 factor)
If the Odor of the wound is normal, the score is +1. A malodorous odor receives a -1.
Pain at Rest and Pain with Movement (2 factors)
Finally, Pain at rest and with movement are assessed. If there is no change in pain level, the Factor Score is 0. If pain decreases, the Factor Score is +1. If pain increased from the last assessment, -1 is assigned.
In summary, below are the 12 factors and how a value or a change in each value is scored for each:
To better understand how the 12-Factor Heal Score is calculated let's look at two different wounds.
Wound 1
This example shows data from two assessments (2/1 and 2/5). The 12-Factor Heal Score is a total of each of the factor scores. In this wound, the score is a -2. Some of the factors are improving like length of wound and epithelial %. Others factors are getting worse (deteriorating) like width and exudate amount. While other factors there is no change. A score of -2 indicates this mix of results. Keep in mind its not only important to know the raw score comparing two assessments, but more importantly the trend over several assessments.
Wound 2:
This example shows data from a different wound looking at two assessments (5/30 and 6/5). In this wound, the score is a 11. As you can see almost all factors have a positive change and hence the high score (recall, the highest score achievable is 13).
In summary, looking only at wound area or a few data points may not give you a true picture of wound healing. The Archangel 12-Factor Heal Score looks at a broader range of assessment data to give the clinician a better indication of wound healing. Keep in mind, however, that the 12-Factor Heal Score is a tool and it is ultimately up to the clinician to decide how best to use the Heal Score in their practice.