Perdanakusuma II versus Falanga Score for Chronic Wound Assessment: A Quasi-Experimental Study before and after Structured Training in Surgical Residents

Background: Accurate chronic wound assessment is essential for monitoring healing and guiding clinical management. However, many scoring systems are too complex for routine clinical practice. This study compared the classification accuracy and agreement with an expert reference standard of the Perdanakusuma II and Falanga scoring systems among surgical residents.Methods: A quasi-experimental one-group pretest–posttest study was conducted involving 41 postgraduate year-1-equivalent surgical residents at a tertiary teaching hospital. Participants assessed 20 standardized chronic wound images using both scoring systems before and after structured training. Classification accuracy was compared with expert consensus classifications. Agreement with reference scores was evaluated using intraclass correlation coefficient (ICC2), while scoring deviation was assessed using mean absolute error (MAE). Paired comparisons were analyzed using the Wilcoxon signed-rank test.Results: Both scoring systems demonstrated significant improvement after training (P<0.001). Mean accuracy increased from 41.71%±12.48% to 54.02%±10.62% for the Falanga score and from 56.59%±13.62% to 67.44%±13.56% for the Perdanakusuma II score. The Perdanakusuma II score showed higher accuracy than the Falanga score in both pretest and posttest assessments (P<0.001). Agreement with the reference standard was also consistently higher for the Perdanakusuma II score before and after training (ICC2=0.73 and 0.76) than for the Falanga score (ICC2=0.39 and 0.62). MAE values were consistently lower for the Perdanakusuma II score.Conclusion: Both scoring systems demonstrated improved performance following structured training. However, the Perdanakusuma II score showed higher accuracy, stronger agreement with the reference standard, and lower scoring deviation, supporting its potential utility for surgical training and routine clinical application.