The End of the Prologue and a Call for Better Epidemiology

Dear Readers:

We all have read them, and many of us have written the first 1 to 3 paragraphs of every wound care paper. They usually read like such: “Diabetes is a very bad disease, it is growing in proportion of the population (at this point we insert some relatively dated statistic, and then we state the percentage of people with diabetes who were going to get a diabetic foot ulcer, of note these numbers are not usually grounded on actual data).” We also do the same thing with venous ulcers, and to some extent with pressure injuries.

In general, this form of an introduction is repetitive and does not introduce any new information. For the readers of this wound care journal, these actually represent common knowledge, because the information is known by the majority of people and can be found in a number of sources. With that being said, none of these papers are actually epidemiology papers. In most cases when the peer reviewers and editorial staff review the citations, they find that they often are opinion pieces, or not based on sound epidemiology. However, one area in which this may not be true is in the international papers or Global Clinical Perspective articles. In these settings, sometimes the epidemiology is not always common knowledge.

As an author, I realize that a portion of this introduction or prologue is written in part to justify the purpose of the study and/or the manuscript. However, I argue that the informed reader understands the general reason that the study was undertaken and why the paper is being published. I usually see these first couple of paragraphs as a warmup; certainly when a resident or fellow writes a paper you can see them starting to get their “gears meshed” correctly when coming out of the introduction. Though I would argue that the introductions should be much more succinct. 

The authors can recognize the exact problem that they are pursuing; discuss a little bit more about the product, process, algorithm, or other intervention they are studying; and discuss exactly why that particular intervention is so interesting. I think the reader can assume that the physiologic problem that the investigator(s) is trying to intervene on is significant enough for the intervention to occur.

On the other hand, I would certainly welcome much better epidemiology for the disease processes we treat. Some examples might include: what number of patients with type 2 diabetes experience at least 1 diabetic foot ulcer? What is the severity of that diabetic foot ulcer, how many are neuropathic, and how many are ischemic? These are not numbers that we really know. What are the true numbers of patients below the age of 68 that have anatomically proven venous leg ulcers?  Currently, we are left to make educated assumptions about these disease states.

Personally, I think it is best that we recognize our limitations and work on improving our data. At the same time, I would say that we can certainly recognize that the pathophysiology the wound specialist treats is always important and always significant, yet that we need better therapies. In some cases, especially international articles, the epidemiology of the disease process may be unique and warrants review and publication. However, in the majority of our papers at present, I would argue that we can skip the first 1 to 3 paragraphs (as noted above), and understand that the paper we are reading has a purpose and a significance.  

John C. Lantis II, MD, FACS

Editor-in-Chief, Wounds 

woundseditor@hmpglobal.com