Modification and validation of the Bluebelle Wound Healing Questionnaire (WHQ) for assessing surgical site infection in wounds healing by secondary intention

Background Surgical wounds healing by secondary intention are common. Healing is often complicated by surgical site infection (SSI). SSI assessment is important to guide treatment but existing methods generally require in-person assessment, making them resource intensive. A validated patient-reported SSI outcome measure may be useful to overcome this limitation. Aim To modify and validate the Bluebelle Wound Healing Questionnaire (WHQ) for wounds healing by secondary intention. Methods The 18-item Bluebelle WHQ developed for wounds healing by primary intention was modified to make it applicable to secondary healing wounds. Testing was performed as part of the SWHSI-2 randomised trial assessing negative pressure wound dressings versus standard care. Participants completed the WHQ at five timepoints; in-person (baseline, post-healing) and by post (3, 6, 12 months). A reference SSI assessment was performed by a research nurse at the time of wound healing. Acceptability and criterion validity (ability of the Bluebelle WHQ to discriminate between SSI/no SSI) were explored by examining questionnaire return rates, levels of missing data and total score sensitivity/specificity values (receiver operating characteristic curve (ROC)). Results Baseline in-person questionnaire return rates were highest (672/686; 98%), with postal return rates of 428/615 (68.5%), 274/416 (65.9%) and 186/296 (62.8%) at follow up points. Overall, low levels of item-missing data were observed with few problems completing the questionnaire reported. Ability to discriminate between SSI/no SSI was good (Area under ROC=0.796) Conclusion The modified Bluebelle WHQ is a valuable tool for post-discharge assessment of wounds healing by secondary intention. It is recommended for use in research and clinical practice.