Assessing And Monitoring Wound Progression With The Bates-Jensen Wound Assessment Tool

I recently read several studies that discussed the Bates-Jensen Wound Assessment Tool (BWAT) scores.^1-4 While reading the study, I realized I was not familiar with this type of wound assessment tool. So what is it?

One can use this tool to measure/grade a wound initially and use it at regular intervals to track and evaluate the effectiveness of therapy. The BWAT consists of 15 items, two of which are not scored (location and shape). The sum of the remaining 13 items is the total BWAT score.

One can score each item from 1 to 5 to provide an assessment. A score of 1 indicates the healthiest and 5 indicates the unhealthiest attribute for each characteristic. After assessing and scoring each item, take the sum of the 13 sub-scores to arrive at a total score. One can plot the total BWAT as a continuum and provide a visual picture of wound progression of healing or non-healing of a wound.

Here are the 13 items the BWAT assesses:

1. Size (use a ruler to measure the longest and widest aspect of the wound surface in centimeters; multiply length x width)

2. Depth (depth, thickness, most appropriate to the wound)

3. Edges (indistinct, attached, not attached, rolled under, hyperkeratosis, fibrotic)

4. Undermining

5. Necrotic tissue type (predominant type of necrotic issue)

6. Necrotic tissue amount

7. Exudate type

8. Exudate amount

9. Skin color surrounding wound (assess tissues within 4 cm of wound edge)

10. Peripheral tissue edema

11. Peripheral tissue induration

12. Granulation tissue

13. Epithelialization

An additional asset of BWAT is using the score to measure wound severity. This is important since the goal of wound care is to reduce wound severity. The total BWAT scores are divided into four severity categories:

13–20 = minimal severity

21–30 = mild severity

31–40 = moderate severity

41–65 = extreme severity

After reviewing the literature about this wound assessment management tool, I realized that my documentation for monitoring and following the progression of wounds needs to be more detailed. It is important that all practitioners use the same tool for each patient in order to provide continuity of care for our wound care patients. 

What wound assessment tool do you use in your practice?

References

1. Available at https://www.geronet.med.ucla.edu/centers/borun/modules/Pressure_ulcer_prevention/puBWAT.pdf .

2. Sussman C, Bates-Jensen BM. Tools to measure wound healing. In Wound Care: A Collaborative Practice Manual. Wolters Kluwer Health, Philadelphia, 2007, Chapter 6, p. 159.

3. Harris C, Bates-Jensen B, Parslow N, Raizman R, Singh M, Ketchen R. J Wound Ostomy Continence Nurs. 2010; 37(3):253-9.

4. Greatrex-White S, Moxey H. Wound assessment tools and nurses’ needs: an evaluation study. Int Wound J. 2013; 12(3):293-301.