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Value of a modified clinical signs and symptoms of infection checklist for leg ulcer management. BJS 2010; 97: 664-670.

Published: 22nd March 2010

Authors: L. A. Dennis, J. C. Dumville, N. Cullum, J. M. Bland


The aim of this study was to analyse the validity of a modified Clinical Signs and Symptoms Checklist used to measure infection in a sample of patients with a leg ulcer.


Data from patients recruited to a randomized controlled trial evaluating larval therapy (VenUS II) were analysed using factor analysis to identify the underlying checklist structure. Linear regression analysis identified whether checklist items, patient characteristics and subjective judgement of infection could predict bacterial load.


There were several redundant checklist items when implemented in this sample and items forming the scale had low internal consistency (α = 0·27). No clear structure to the checklist was detected, with only one underlying theme revealed which had low internal consistency (α = 0·45). Predictions of bacterial count were possible using the emerged theme, some checklist items and ankle circumference, but not using clinicians' subjective judgement alone (P = 0·315).


The modified Clinical Signs and Symptoms Checklist does not currently represent a valid tool to measure infection in leg ulcers. Some checklist items may predict bacterial load and may be better than subjective judgement alone. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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