Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
Aims: To separately evaluate peripheral arterial occlusive disease (PAOD) and foot ulcer and amputation history in a diabetic foot risk classification to predict foot complications.
Methods: We evaluated 1,666 diabetic patients for of 27.2 ± 4.2 months. Patients underwent a detailed foot assessment and were followed at regular intervals. We used a modified version of the International Working Group on the Diabetic Foot's (IWGDF) Risk Classification to assess complications during the follow-up period.
Results: There were more ulcerations, infections, amputations and hospitalizations as risk group increased ( X2 for trend p<0.001). When Risk Category 2 (neuropathy and deformity and/or PAOD) was stratified by PAOD, there were more complications in PAOD patients, (p<0.01). When Risk Group 3 patients (ulceration or amputation history) were separately stratified, there were more complications in subjects with previous amputation (p<0.01).
Conclusion: We propose a new risk classification that predicts future foot complications better than the IWGDF.
Aims The aim was to compare the use of four different systems of foot ulcer classification in a consecutive population with diabetes presenting to a specialist clinic in Dar es Salaam, Tanzania.
Methods Clinical data were collected prospectively in all patients presenting with foot ulcers between 3 January 2003 and 30 September 2005, and were used retrospectively to classify their ulcers using the Meggitt/Wagner, University of Texas (UT), Size (Area and Depth), Sepsis, Arteriopathy, and Denervation [S(AD)SAD] and Perfusion, Extent/size, Depth/tissue loss, Infection and Sensation (PEDIS) systems. Comparison was made between the strength of the associations between baseline characteristics of each system and outcome determined at 5 December 2005, using linear by linear association.
Results The strongest statistical associations (P < 0.001) were observed between percent healing and Wagner score (chi(2)= 85.923), depth [S(AD)SAD, PEDIS and UT grade, 70.558], infection [S(AD)SAD, 61.774; PEDIS, 37.924] and UT stage (32.929). Weaker but significant (P < 0.001) associations were observed between percent healing and neuropathy [S(AD)SAD, PEDIS 12.475] and peripheral arterial disease [S(AD)SAD, PEDIS 10.799], as well as cross-sectional area [S(AD)SAD 4.387, P = 0.036].
Conclusion The strength of the statistical association between outcome and both neuropathy and infection contrasts with findings in series previously reported from the USA and UK, and highlights the differences which may be found in different populations. These differences have implications for any system of classification chosen to compare the effectiveness of management in different centres in different countries.
Use of the SINBAD classification system and score in comparing outcome of foot ulcer management in three continents.
Ince P, Abbas Z, Lutale J, Basit A, Mansoor Ali S, Chohan F, Morbach S, Möllenberg J, Game F, Jeffcoate W.
Diabetes Care. 2008 Feb 25 [Epub ahead of print]
Quote:
Objective: To compare populations and outcomes of diabetic foot ulcers managed in UK, Germany, Tanzania and Pakistan, and to explore the use of a new score of ulcer type in comparing outcome between different countries
Research Design and Methods: Data from a series of 449 patients managed in UK were used to evaluate the new simplified system of classification, and to derive an aggregate score. The use of the score was then explored using data from series managed in Germany (239), Tanzania (479) and Pakistan (173).
Results: A highly significant difference was found in time to healing between ulcers of increasing score in the UK series (p=0.000, Kruskal Wallis). When data from all centers were examined, a step up in days to healing was noted for those with scores of 3 or more (out of 6). Examination of baseline variables contributing to outcome revealed differences between centers: ischemia, ulcer area and depth contributing to outcome in UK; ischemia, area, depth and infection in Germany; depth, infection and neuropathy in Tanzania and depth alone in Pakistan.
Conclusions: Any system of classification designed for general implementation must encompass all the variables which contribute to outcome in different communities. The adoption of a simple score based on these variables, the SINBAD score, may prove a useful tool to predict ulcer outcome and to enable comparison between different centers.
Objective: The aim was to compare three ulcer classification systems as predictors of the outcome of diabetic foot ulcers: the Wagner, the University of Texas (UT) and the S(AD)SAD system in a specialist clinic in Brazil.
Methods: Ulcer area, depth, appearance, infection, and associated ischaemia and neuropathy were recorded in a consecutive series of 94 subjects. A novel score, the S(AD)SAD score, was derived from the sum of individual items of the S(AD)SAD system, and was evaluated. Follow-up was for at least 6 months. The primary outcome measure was the incidence of healing.
Results: Mean age was 57.6 years; 57 (60.6%) were male. 48 ulcers (51.1%) healed without surgery; 11 (12.2%) subjects underwent minor amputation. Significant differences in terms of healing were observed for depth (p=0.002), infection (p=0.006) and denervation (p=0.002) using the S(AD)SAD system, for UT Grade (p=0.002) and Stage (p=0.032), and for Wagner grades (p=0.002). Ulcers with a S(AD)SAD score of </=9 (total possible 15) were 7.6 times more likely to heal than scores >/=10 (p<0.001).
Conclusions: All three systems predicted ulcer outcome. The S(AD)SAD score of ulcer severity could represent a useful addition to routine clinical practice routine. The association between outcome and ulcer depth confirms earlier reports. The association with infection was stronger than reported from centres in Europe or N America. The very strong association with neuropathy has only previously been observed in Tanzania. Studies designed to compare outcome in different countries should adopt systems of classification which are valid for the populations studied.
New diabetic foot classification needed
Linear Mode
