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Prediction of Diabetic Foot Ulcer Occurrence Using Commonly Available Clinical Information - The Seattle Diabetic Foot Study Diabetes Care 29:1202-1207, 2006
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OBJECTIVE—The ability of readily available clinical information to predict the occurrence of diabetic foot ulcer has not been extensively studied. We conducted a prospective study of the individual and combined effects of commonly available clinical information in the prediction of diabetic foot ulcer occurrence.
RESEARCH DESIGN AND METHODS—We followed 1,285 diabetic veterans without foot ulcer for this outcome with annual clinical evaluations and quarterly mailed questionnaires to identify foot problems. At baseline we assessed age; race; weight; current smoking; diabetes duration and treatment; HbA1c (A1C); visual acuity; history of laser photocoagulation treatment, foot ulcer, and amputation; foot shape; claudication; foot insensitivity to the 10-g monofilament; foot callus; pedal edema; hallux limitus; tinea pedis; and onychomycosis. Cox proportional hazards modeling was used with backwards stepwise elimination to develop a prediction model for the first foot ulcer occurrence after the baseline examination.
RESULTS—At baseline, subjects were 62.4 years of age on average and 98% male. Mean follow-up duration was 3.38 years, during which time 216 foot ulcers occurred, for an incidence of 5.0/100 person-years. Significant predictors (P 0.05) of foot ulcer in the final model (hazard ratio, 95% CI) included A1C (1.10, 1.06–1.15), impaired vision (1.48, 1.00–2.18), prior foot ulcer (2.18, 1.61–2.95), prior amputation (2.57, 1.60–4.12), monofilament insensitivity (2.03, 1.50–2.76), tinea pedis (0.73, 0.54–0.98), and onychomycosis (1.58, 1.16–2.16). Area under the receiver operating characteristic curve was 0.81 at 1 year and 0.76 at 5 years.
CONCLUSIONS—Readily available clinical information has substantial predictive power for the development of diabetic foot ulcer and may help in accurately targeting persons at high risk of this outcome for preventive interventions.
OBJECTIVE—To prospectively determine risk factors for foot infection in a cohort of people with diabetes.
RESEARCH DESIGN AND METHODS—We evaluated then followed 1,666 consecutive diabetic patients enrolled in a managed care–based outpatient clinic in a 2-year longitudinal outcomes study. At enrollment, patients underwent a standardized general medical examination and detailed foot assessment and were educated about proper foot care. They were then rescreened at scheduled intervals and also seen promptly if they developed any foot problem.
RESULTS—During the evaluation period, 151 (9.1%) patients developed 199 foot infections, all but one involving a wound or penetrating injury. Most patients had infections involving only the soft tissue, but 19.9% had bone culture–proven osteomyelitis. For those who developed a foot infection, compared with those who did not, the risk of hospitalization was 55.7 times greater (95% CI 30.3–102.2; P < 0.001) and the risk of amputation was 154.5 times greater (58.5–468.5; P < 0.001). Foot wounds preceded all but one infection. Significant (P < 0.05) independent risk factors for foot infection from a multivariate analysis included wounds that penetrated to bone (odds ratio 6.7), wounds with a duration >30 days (4.7), recurrent wounds (2.4), wounds with a traumatic etiology (2.4), and presence of peripheral vascular disease (1.9).
CONCLUSIONS—Foot infections occur relatively frequently in individuals with diabetes, almost always follow trauma, and dramatically increase the risk of hospitalization and amputation. Efforts to prevent infections should be targeted at people with traumatic foot wounds, especially those that are chronic, deep, recurrent, or associated with peripheral vascular disease.
The second abstract above, has this press release associated with it: Landmark Study On Diabetic Foot Infection Published - Renowned Researchers At 3 Universities Unveil Startling Data About Infection-induced Amputation
02 Jun 2006 - 14:00pm (PDT)
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Persons with diabetes who develop an infection are at a 55-fold greater risk for hospitalization, and an alarming 154-fold greater risk for amputation. These are some of the startling figures emanating from the first population-based study on diabetic foot infection. Researchers from Texas A&M University, Rosalind Franklin University of Medicine and Science, and the University of Washington collected data on nearly 1,700 patients over a two-year period.
"The results strongly suggested that foot infections are common and complex. They are also costly in terms of morbidity," noted Dr. Lawrence A. Lavery of Texas A&M, the lead author on the study.
The study also found that nearly 9 in 10 amputations performed are instigated by an infection. "This was perhaps the most interesting figure in the study," noted David G. Armstrong, DPM, PhD, Professor of Surgery and Director of Scholl's Center for Lower Extremity Ambulatory Research at Rosalind Franklin University and one of the study's principal investigators.
"It is infection that is the spark that led to nearly all amputations in this study," said Armstrong. "Poor circulation, while critically important, did not necessarily cause amputation. It determined the level of amputation. This subtlety makes a significant difference when designing strategies for prevention."
The study is published in the June issue of the journal Diabetes Care.
CONTEXT AND OBJECTIVE: Diabetic patients present high risk of having to undergo minor or major amputation during their lifetimes, because of ischemia or infection. The aim of this study was to identify and quantify risk factors for major amputation in diabetic patients with foot infections.
DESIGN AND SETTING: Retrospective clinical-surgical trial at the Vascular Surgery Service of Santa Casa de São Paulo.
METHODS: Ninety-nine patients with diabetic foot infections who underwent 129 hospitalizations in the Vascular Surgery Unit were analyzed in accordance with a pre-established protocol to compare two groups of diabetic patients: one that underwent major amputations and the other that underwent minor amputations or debridements. The patients were predominantly male, in their sixth decade of life, and had type 2 diabetes mellitus. Chronic arterial insufficiency, age, diabetes mellitus duration, ascending lymphangitis, calcaneal lesions, Wagner's classification, laboratory tests and different microorganisms in deep tissue cultures were the risk factors evaluated in all patients.
RESULTS: The statistically significant risk factors for major amputation included age, ascending lymphangitis (odds ratio, OR: 2.5), calcaneal lesions (OR: 10.5), Wagner grade 5 lesions (OR: 3.4), chronic arterial insufficiency without possibility of revascularization (OR: 5.4) and diabetes duration. Presence of Gram-positive microorganisms was associated with the need of major amputation. The serum urea, creatinine, glucose and white blood cell levels were not significant risk factors for major amputation.
CONCLUSIONS: The risk factors for major amputation were: age, ascending lymphangitis, calcaneal lesions, Wagner grade 5 lesions, arterial insufficiency, diabetes duration and Gram-positive microorganisms in cultures.
Re: Predictors of diabetic foot ulcers & infections
Risk factors and healing impact of multidrug-resistant bacteria in diabetic foot ulcers.
Richard JL, Sotto A, Jourdan N, Combescure C, Vannereau D, Rodier M, Lavigne JP; on behalf of the Nîmes University Hospital Working Group on the Diabetic Foot (GP30). Diabetes Metab. 2008 Jul 14. [Epub ahead of print]
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AIM: To determine the risk factors for acquiring multidrug-resistant organisms (MDRO) and their impact on outcome in infected diabetic foot ulcers.
METHODS: Patients hospitalized in our diabetic foot unit for an episode of infected foot ulcer were prospectively included. Diagnosis of infection was based on clinical findings using the International Working Group on the Diabetic Foot-Infectious Diseases Society of America (IWGDF-ISDA) system, and wound specimens were obtained for bacterial cultures. Each patient was followed-up for 1 year. Univariate analysis was performed to compare infected ulcers according to the presence or absence of MDRO; logistic regression was used to identify explanatory variables for MDRO presence. Factors related to healing time were evaluated by univariate and multivariate survival analyses.
RESULTS: MDRO were isolated in 45 (23.9%) of the 188 patients studied. Deep and recurrent ulcer, previous hospitalization, HbA(1c) level, nephropathy and retinopathy were significantly associated with MDRO-infected ulceration. By multivariate analysis, previous hospitalization (OR=99.6, 95% CI=[19.9-499.0]) and proliferative retinopathy (OR=7.4, 95% CI=[1.6-33.7]) significantly increased the risk of MDRO infection. Superficial ulcers were associated with a significant decrease in healing time, whereas neuroischaemic ulcer, proliferative retinopathy and high HbA(1c) level were associated with an increased healing time. In the multivariate analysis, presence of MDRO had no significant influence on healing time.
CONCLUSION: MDRO are pathogens frequently isolated from diabetic foot infection in our foot clinic. Nevertheless, their presence appears to have no significant impact on healing time if early aggressive treatment, as in the present study, is given, including empirical broad-spectrum antibiotic treatment, later adjusted according to microbiological findings.
Re: Predictors of diabetic foot ulcers & infections
Foot ulcer risk and location in relation to prospective clinical assessment of foot shape and mobility among persons with diabetes.
Cowley MS, Boyko EJ, Shofer JB, Ahroni JH, Ledoux WR. Diabetes Res Clin Pract. 2008 Sep 29. [Epub ahead of print]
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AIMS: We assessed baseline clinical foot shape for 2939 feet of diabetic subjects who were monitored prospectively for foot ulceration.
METHODS: Assessments included hammer/claw toes, hallux valgus, hallux limitus, prominent metatarsal heads, bony prominences, Charcot deformity, plantar callus, foot type, muscle atrophy, ankle and hallux mobility, and neuropathy. Risk factors were linked to ulcer occurrence and location via a Cox proportional hazards model.
RESULTS: Hammer/claw toes (hazard ratio [HR] (95% confidence interval [CI])=1.43 (1.06, 1.94) p=0.02), marked hammer/claw toes (HR=1.77 (1.18, 2.66) p=0.006), bony prominences (HR=1.38 (1.02, 1.88), p=0.04), and foot type (Charcot or drop foot vs. neutrally aligned) (HR=2.34 (1.33, 4.10), p=0.003) were significant risk factors for ulceration adjusting for age, body mass index, insulin medication, ulcer history and amputation history. With adjustment for neuropathy only hammer/claw toes (HR=1.40 (1.03, 1.90), p=0.03) and foot type (HR=1.76 (1.04, 3.04), p=0.05) were significantly related to ulceration. However, there was no relationship between ulcer location and foot deformity.
CONCLUSIONS: Certain foot deformities were predictive of ulceration, although there was no relationship between clinical foot deformity and ulcer location.
AIMS: The current study aims to identify risk factors for diabetic foot ulcer and their impact on the outcome of the disease.
METHODS: Three hundred diabetic patients were enrolled in the study. One hundred eighty subjects with diabetic foot ulcer and 120 diabetic controls without foot lesions. All expected risk factors were studied in all patients and after a follow up period, patients with diabetic foot ulcer were classified into group A (patients with healed ulcers) and group B (patients with persistent ulcer or ended by amputation). The risk factors were reanalyzed in both groups to find out their impact on the outcome of the disease.
RESULTS: The following variables were significant factors for foot ulceration: Male gender (P=0.009), previous foot ulcer (P=0.003), peripheral vascular disease (P=0.004), and peripheral neuropathy (P=0.006). Also lack of frequent foot self-examination was independently related to foot ulcer risk. The outcome was related to longer diabetes duration (P=0.004), poor glycaemic control (P=0.006) and anaemia (P=0.003) and presence of infection (P<0.001).
CONCLUSIONS: Peripheral vascular disease and peripheral neuropathy together with lack of foot self-examination, poor glycaemic control and anaemia are main significant risk factors for diabetic foot ulceration.
AIMS/HYPOTHESIS: In 2006 a risk stratification model was developed by Boyko et al. to predict foot ulceration in patients with diabetes, using seven commonly available clinical variables. We sought to validate and optimise this clinical prediction rule in a different setting.
METHODS: A retrospective cohort study was conducted on all patients with diabetes attending the podiatry section of a diabetic foot clinic at a tertiary hospital in Portugal (n = 360). Assessment at baseline included variables evaluated in the previous study and other relevant variables.
RESULTS: Type 2 diabetes was present in 98% of patients, 45% were men and (at baseline) the median age was 65 years. Median follow-up was 25 months (range 3-86), during which 94 patients (26%) developed a foot ulcer. Boyko's model had an area under the receiver operating curve of 0.83 (95% CI 0.78-0.88). The corresponding value for the optimised model, which included the footwear risk variable, was 0.88 (95% CI 0.84-0.91). Both models had high classification accuracy for prediction of foot ulceration. However, the optimised model tended to produce higher specificity and positive likelihood ratio values at all levels.
CONCLUSIONS/INTERPRETATION: This study confirmed that Boyko's proposed model has a high capacity to predict foot ulceration in diabetes patients of both sexes. Our results suggest that the inclusion of a further footwear variable could improve the model. Nevertheless, prospective validation in a larger population is still necessary.
Re: Predictors of diabetic foot ulcers & infections
The risk of foot ulceration in people with diabetes screened in community settings: findings from a cohort study.
Crawford F, McCowan C, Dimitrov BD, Woodburn J, Wylie GH, Booth E, Leese GP, Bekker HL, Kleijnen J, Fahey T. QJM. 2010 Dec 23. [Epub ahead of print]
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BACKGROUND: Annual foot checks are recommended in patients with diabetes mellitus (DM) to identify those at risk of foot ulceration. Systematic reviews have found few studies evaluating the predictive value of tests in community-based diabetic populations.
AIM: To quantify the predictive value of clinical risk factors in relation to foot ulceration in a community population.
METHODS: A cohort of 1192 people with diabetes receiving care in community settings was recruited and a screening procedure, covering symptoms, signs and diagnostic tests was conducted at baseline. At an average 1-year follow-up patients who developed a foot ulcer were identified by an independent blind assessor. Multivariable analysis was performed to identify clinical predictors of foot ulceration.
Findings: The incidence of foot ulceration was 1.93% [95% confidence interval (CI) 1.27-2.89). Three time-independent clinical predictors with five factors were selected: previous amputation [odds ratio (OR) 14.7, 95% CI 3.1-69.5), use of insulin before 3 months with inability to distinguish between cool and cold temperatures (OR 2.97, 95% CI 1.9-4.5) and failure to obtain at least one blood pressure reading for the calculation of ankle-brachial index with the failure to feel touch with a 10-g monofilament (OR 1.7, 95% CI 1.3-2.2).
Interpretation: Recommendations for annual diabetic foot check in low-risk, community-based patients should be reviewed as absolute events of ulceration are low. The accuracy of foot risk assessment tools to predict ulceration requires evaluation in randomized controlled trials with concurrent economic evaluations.
AIMS:
An epidemiological survey of diabetic foot infections (DFIs) in Lisbon, stratifying the bacterial profile based on patient demographical data, diabetic foot characteristics (PEDIS classification), ulcer duration and antibiotic therapy.
METHODS:
A transversal observational multicenter study, with clinical data collection using a structured questionnaire and microbiological products (aspirates, biopsies or swabs collected using the Levine method) of clinically infected foot ulcers of patients with diabetes mellitus (DM).
RESULTS:
Forty-nine hospitalized and ambulatory patients were enrolled in this study, and 147 microbial isolates were cultured. Staphylococcus was the main genus identified, and methicillin-resistant Staphylococcus aureus (MRSA) was present in 24.5% of total cases. In the clinical samples collected from patients undergoing antibiotic therapy, 93% of the antibiotic regimens were considered inadequate based on the antibiotic susceptibility test results. The average duration of an ulcer with any isolated multi-drug resistant (MDR) organism was 29 days, and previous treatment with fluoroquinolones was statistically associated with multi-drug resistance.
CONCLUSIONS:
Staphylococcus aureus was the most common cause of DFIs in our area. Prevalence and precocity of MDR organisms, namely MRSA, were high and were probably related to previous indiscriminate antibiotic use. Clinicians should avoid fluoroquinolones and more frequently consider the use of empirical anti-MRSA therapy.
Re: Predictors of diabetic foot ulcers & infections
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The risk of foot ulceration in people with diabetes screened in community settings: findings from a cohort study.
Crawford F, McCowan C, Dimitrov BD, Woodburn J, Wylie GH, Booth E, Leese GP, Bekker HL, Kleijnen J, Fahey T.
QJM. 2010 Dec 23. [Epub ahead of printFindings: The incidence of foot ulceration was 1.93% [95% confidence interval (CI) 1.27-2.89). Three time-independent clinical predictors with five factors were selected: previous amputation [odds ratio (OR) 14.7, 95% CI 3.1-69.5), use of insulin before 3 months with inability to distinguish between cool and cold temperatures (OR 2.97, 95% CI 1.9-4.5) and failure to obtain at least one blood pressure reading for the calculation of ankle-brachial index with the failure to feel touch with a 10-g monofilament (OR 1.7, 95% CI 1.3-2.2).
Interpretation: Recommendations for annual diabetic foot check in low-risk, community-based patients should be reviewed as absolute events of ulceration are low. The accuracy of foot risk assessment tools to predict ulceration requires evaluation in randomized controlled trials with concurrent economic evaluations.
Intersting thread, even if it goes back a bit.
Having screened quite a lot of diabetic feet in the community setting, and seen a few people both high and low risk have an injury develop infections and end up in hospital +/- amputation
I've wondered if I can improve on what I do.
I check for the usual suspects, loss of protective sensation, peripheral arterial supply, previous Hx of diabetic wound/amputation, foot deformity, inadequate footwear.
If available I'll have a look at their glycaemic control.
This establishes if the patient is at the high or low risk for diabetic foot wound, although as the quoted study suggests may not be "predictive"
I wonder we would get a more predictive result ( and indication of risk) from an assessment of patients susceptabiliy for "risk taking behaviour" or "lifestyle" .Hopefully something more in enlightening than being male and a smoker.
My current assessment for diabetic foot risk only covers the currently accepted objective "medical" risk factors , which when found will determine my advice and management of the patient.
However I'm thinking that my risk assessment may not really account for the actual ( predictive?) risk and that my assessment of the client may not account for the clients state of readiness to recieve some of my advice/care.
Interested to hear what others see as risk/predictive factors and if any have a structured approach to assesssing clients state of engagement in consultation.
Re: Predictors of diabetic foot ulcers & infections
Risk factors for recurrence of diabetic foot ulcers: prospective follow-up analysis of a Eurodiale subgroup.
Dubský M, Jirkovská A, Bem R, Fejfarová V, Skibová J, Schaper NC, Lipsky BA. Int Wound J. 2012 Jun 19.
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Few studies have examined factors associated with diabetic foot ulcer (DFU) recurrence. Using data from patients enrolled in the prospective Eurodiale DFU study, we investigated the frequency of, and risk factors for, DFU recurrence after healing during 3-year follow-up period. At our site, 93 Eurodiale enrolled patients had a healed DFU. Among these, 14 died; of the remaining 79 patients we enrolled 73 in this study. On entry to the Eurodiale study we assessed: demographic factors (age, sex, distance from hospital); diabetes-related factors (duration, HbA1c levels); comorbidities (obesity, renal failure, smoking, alcohol abuse); and DFU-related factors (peripheral arterial disease, ulcer infection, c-reactive protein [CRP]; foot deformities). During the 3-year follow-up, a DFU recurred in 42 patients (57·5%). By stepwise logistic regression of findings at initial DFU presentation, the significant independent predictors for recurrence were plantar ulcer location (odds ratio [OR] 8·62, 95% CI 2·2-33·2); presence of osteomyelitis (OR 5·17, 95% CI 1·4-18·7); HbA1c > 7·5% ([DCCT], OR 4·07, 95% CI 1·1-15·6); and CRP > 5 mg/l (OR 4·27, 95% CI 1·2-15·7). In these patients with a healed DFU, the majority had a recurrence of DFU during a 3-year follow-up, despite intensive foot care. The findings present at diagnosis of the initial DFU that were independent risk factors associated with ulcer recurrence (plantar location, bone infection, poor diabetes control and elevated CRP) appear to define those at high risk for recurrence, but may be amenable to targeted interventions.
Re: Predictors of diabetic foot ulcers & infections
Predictive factors for diabetic foot ulceration: a systematic review.
Monteiro-Soares M, Boyko E, Ribeiro J, Ribeiro I, Dinis-Ribeiro M. Diabetes Metab Res Rev. 2012 Jun 22.
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BACKGROUND AND AIM:
Improving ability to predict and prevent diabetic foot ulcer (DFU) is imperative due to the high personal and financial costs of this complication. We therefore conducted a systematic review in order to identify all studies of factors associated with DFU and assess whether available DFU risk stratification systems incorporate those factors of highest potential value.
MATERIAL AND METHODS:
We performed a search in PubMed for studies published until April 2011 that analysed the association between independent variables and DFU. Articles were selected by 2 investigators independent and blind to each other. Divergence was solved by a third investigator.
RESULTS:
A total of 71 studies were included and evaluated the association between DFU and more than 100 independent variables. The variables most frequently assessed were age, gender, diabetes duration, body mass index, HbA1C and neuropathy diagnostic tests. DFU prevalence varied greatly among studies. The majority of the identified variables were assessed by only 2 or fewer studies. Diabetic neuropathy, peripheral vascular disease, foot deformity and previous DFU or lower extremity amputation - which are the most common variables included in risk stratification systems - were consistently associated with DFU development.
CONCLUSION:
Existing DFU risk stratification systems often include variables shown repeatedly in the literature to be strongly predictive of this outcome. Improvement of these risk classification systems though is impaired due to deficiencies noted including a great lack of standardization in outcome definition and variable selection and measurement
Re: Predictors of diabetic foot ulcers & infections
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Originally Posted by NewsBot
Risk factors for recurrence of diabetic foot ulcers: prospective follow-up analysis of a Eurodiale subgroup.
Dubský M, Jirkovská A, Bem R, Fejfarová V, Skibová J, Schaper NC, Lipsky BA. Int Wound J. 2012 Jun 19.
Press Release on this study: Recurring diabetic foot ulcers ‘predictable’
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The risk for recurring diabetic foot ulcers (DFUs) is predicted by clinical characteristics, such as existing ulcer location, bone infection, and diabetes control, demonstrates research published in International Wound Journal.
"Knowing these risk factors may allow clinicians and health-care systems to target heightened efforts at prevention of re-ulceration after healing to selected high-risk patients," say Michal Dubský (Institute for Clinical and Experimental Medicine, Prague, Czech Republic) and co-workers.
The team followed up 73 patients for 3 years after successful healing of a DFU, defined as full skin recovery for at least 6 weeks. Overall, 57.5% developed a further DFU.
In multivariate analysis, accounting for demographics, diabetes factors, comorbidity, and DFU-related factors, patients were a significant 8.62 times more likely to experience recurrent DFU if their original ulcer was located on the plantar surface of the forefoot, mid-foot, or heel than if positioned on the dorsum foot, toes, or heel.
Recurrent DFU was also significantly associated with osteomyelitis (odds ratio [OR]=5.17), poor diabetes control, defined as a glycated hemoglobin level above 7.5% (OR=4.07), and a C-reactive protein level above 5 mg/ml (OR=4.27).
Further analysis of the 30 patients with osteomyelitis showed that the risk for recurring DFU did not differ significantly between patients treated with antibiotics alone or with surgery. Nor was there a significant difference in recurrence between patients with bone infection in their toes and those affected in other parts of the foot.
"In light of the high risk of a recurrent ulceration, we believe it would be appropriate to develop prevention programmes that focus on patients identified as being in the highest risk groups," Dubský et al conclude.
"This might also include efforts to educate the patients and their health-care providers on methods that have been shown to be effective in preventing DFU."
Re: Predictors of diabetic foot ulcers & infections
Indexing Severity of Diabetic Foot Infection With 99mTc-White Blood Cell Single Photon Emission Computed Tomography/Computed Tomography Hybrid Imaging.
Erdman WA, Buethe J, Bhore R, Ghayee HK, Thompson C, Maewal P, Anderson J, Klemow S, Oz OK. Diabetes Care. 2012 Jun 20.
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OBJECTIVEManagement of diabetic foot infection (DFI) has been hampered by limited means of accurately classifying disease severity. New hybrid nuclear/computed tomography (CT) imaging techniques elucidate a combination of wound infection parameters not previously evaluated as outcome prognosticators. Our aim is to determine if a novel standardized hybrid image-based scoring system, Composite Severity Index (CSI), has prognostic value in DFI.
RESEARCH DESIGN AND METHODSMasked retrospective (99m)Tc-white blood cell (WBC) single photon emission CT (SPECT)/CT image interpretation and independent chart review of 77 patients (101 feet) suspected of DFI-associated osteomyelitis at a large municipal hospital between January 2007 and July 2009. CSI scores were correlated with probability of favorable outcome (no subsequent amputation/readmission after therapeutic intervention) during median 342-day follow-up.RESULTSCSI ranged from 0-13. Receiver operating characteristic accuracy for predicting favorable outcome was 0.79 (optimal cutoff CSI, ≤2; odds ratio of therapeutic failure for CSI >2, 15.1 [95% CI 4.4-51.5]). CSI of 0 had a 92% chance of favorable outcome, which fell progressively to 25% as indices rose to ≥7. Image-based osteomyelitis versus no osteomyelitis assessment was less accurate than CSI at predicting outcome (P = 0.016). In patients with intermediate severity (CSI 3-6), treatment failure decreased from 68 to 36% when antibiotic duration was extended to ≥42 days (P = 0.026).
CONCLUSIONS(99m)Tc-WBC SPECT/CT hybrid image-derived wound infection parameters incorporated into a standardized scoring system, CSI, has prognostic value in DFI.
Predictors of diabetic foot ulcers & infections
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