Thank you for the opportunity to respond to Dr Noël, who has raised several interesting concerns about our study. Noël's first concern is our use of the term risk factor, which he finds confusing. The risk factors presented in our study are clinical signs, elements of patient history, and diagnostic tests, all obtained before the initiation of a standard therapy. Note that we studied risk factors for healing, not risk factors for the development of wounds. Our use of the term risk factor is consistent with A Dictionary of Epidemiology,1 a monograph that is sponsored by the International Epidemiology Association. In fact, the term risk factor is used in an identical fashion in the observational study cited by Dr Noël.
Margolis DJ, Berlin JA, Strom BL. Regarding "Risk Factors Associated With the Failure of a Venous Leg Ulcer to Heal"—Reply. Arch Dermatol. 2000;136(3):425-426. doi: