| Sumario: | Background Chronic wounds secondary to conditions, including venous insufficiency, diabetes or unrelieved friction/shear, are a significant burden to patients and healthcare systems. Biofilms are estimated to occupy 60-78% of these wounds. However, they are difficult to detect macroscopically and have no definitive clinical markers. Clinicians are thus advised to assume biofilm presence in all stalled wounds. Incorrect diagnosis of biofilm presence may result in sub-optimal care provision and inadvertent, inappropriate administration of medical interventions. Hypothesis/aim To achieve clinical consensus on which signs, symptoms and/or biomarkers (items) currently reported in the literature are most likely to indicate presence of biofilm in chronic wounds. Methods design, sample, data collection, data analysis An international steering committee of researchers and wound clinicians convened to develop this protocol for a 2-round electronic Delphi process that will recruit ≥30 active clinicians with ≥3 years' clinical experience, ≥50% of which must be in wound care. Participants will rate items on a 9-point Likert scale. Consensus to include items requires ≥70% of participants rating 7-9 and ≤15% rating 1-3. Conclusions The integrity of research findings depends on methodological rigour. Concerns exist regarding the consistency of methods in Delphi studies. Given these concerns, we decided that a review of Delphi methodological dilemmas by a group of experienced clinicians and researchers would be the most appropriate means to optimise the methods for this particular project. Implications for clinical practice Findings will consolidate current clinical opinion on what signifies biofilm in chronic wounds. Delphi methodology should be standardised to develop its rigour.
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