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. 2025 Aug;34(3):100889.
doi: 10.1016/j.jtv.2025.100889. Epub 2025 Mar 18.

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

Rhiannon Macefield  1 , Laura Mandefield  2 , Jane M Blazeby  1 , Caroline Fairhurst  2 , Kalpita Baird  2 , Catherine Arundel  3 , Ian Chetter  4 , Belen Corbacho Martin  2 , Catherine Hewitt  2 , Athanasios Gkekas  2 , Andrew Mott  2 , Dr Pedro Saramago Goncalves  5 , Samantha Swan  2 , David Torgerson  2 , Jacqueline Wilkinson  2 , Sabeen Zahra  2 , Stephen Dixon  6 , Josie Hatfield  6 , Angela Oswald  6 , Jo Dumville  7 , Mr Matthew Lee  8 , Thomas Pinkney  9 , Nikki Stubbs  10 , Lyn Wilson  11 , A Clothier  12 , D Bosanquet  12 , M Blow  12 , C Price  12 , J Todd  13 , T Munro  14 , W Pillay  14 , A Pradhan  14 , A Garnham  15 , M Wall  15 , K Powezka  15 , A Syed  15 , D Gerrard  16 , A Croucher  16 , N Hadjievangelou  16 , A Firth  6 , T Roe  6 , G Smith  6 , C Bicknell  17 , C Carr  17 , E Negbenose  17 , L Tarusan  17 , A Vesey  18 , D Wilson  18 , D Bell  18 , J Fletcher  19 , C Greenwood  19 , T Wallace  19 , S Vallabhaneni  20 , S Holder  20 , J Williams  20 , S Sim  21 , A L Tambyraja  21 , F Kerray  21 , A Ng  22 , M Sylvester  22 , L Slater  22 , S T Rashid  23 , A Palacios  23 , K Feld  23 , S Nandhra  24 , G Stansby  24 , N Parr  24 , L Jones  25 , J Milne  25 , C Stubbs  25 , R Hinchliffe  26 , C Twine  26 , G A Antoniou  27 , C Corbett  27 , S Munt  27 , S Warran  27 , R Fletcher  28 , W Al-Jundi  29 , M Burrows  29 , P Stather  29 , R Barnes  30 , T Woodrow  30 , B Adams  30 , O Agu  31 , Y Gleeson  31 , R D'Souza  31 , L Erete  31 , S Jones  32 , C Checketts  32 , D Bajic  32 , R Matravers  32 , I Loftus  33 , J Budge  33 , B Azhar  33 , M Juszczak  34 , A Syed  34 , R Hancox  35 , C Pearce  35 , N Suggett  35 , A Whitehouse  35 , G Kuhan  36 , S Premnath  36 , N Dattani  37 , V Hollings  37 , F Khasawneh  37 , J AlShakarchi  38 , E Packer  38
Affiliations
Free article

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

Rhiannon Macefield et al. J Tissue Viability. 2025 Aug.
Free article

Abstract

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.

Keywords: Patient reported outcome (PRO); Secondary intention healing; Surgical site infection; Surgical wounds; Wound assessment.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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