A Checklist System to Score Healing Progress of Diabetic Foot Ulcers

Abstract

The aim of this article was to validate the checklist contribution of 10 factors relevant to healing in order to score the severity of diabetic foot ulcers. A total of 235 patients from January 2007 to January 2009 were scored according to the Saint Elian Wound Score System from mild to severe (1 to 3) in the following categories: location, topographic aspects, and number of affected zones, ischemia, infection, edema, neuropathy, depth, area, and wound healing phase. The score sum was graded as I (score ≤10, good prognosis for wound healing), II (11-20, partially foot-threatening), and III (21-30, limb- and life-threatening). The 10 categories showed an increasing trend for score severity. Grade I ulcers were associated with an excellent healing rate of 96% (P < .001) and minor amputations prevailed at grade II (11.2%; odds ratio [OR] = 3, 95% confidence interval [CI] = 0.3-23.6). The chances for major amputation (40.6%; OR = 6.1, 95% CI = 2.7-13.4) and mortality (15.6%; OR = 32.7, 95% CI = 3.7-287) were significantly higher for grade III patients (P < .001). The mean time of healing for grades I, II, and III was 5.8 ± 5.8, 9.4 ± 10.5, and 14.4 ± 12.1 weeks, respectively. In all, 80% of patients achieved total wound healing at 8, 20, and 37 weeks for grades I, II, and III, respectively (P < .001; Kaplan—Meier). The results validated the checklist contribution of 10 wound factors to scoring the severity and healing progress of diabetic foot ulcers.

Keywords

diabetic foot score classification amputations wound healing mortality

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References

Jeffcoate WJ , Macfarlane RM , Fletcher EM The description and classification of diabetic foot lesions. Diabet Med. 1993; 10:676-679.

Armstrong DG , Peters EJ Classification of wounds of the diabetic foot . Curr Diab Rep. 2001;1:233-238.

Oyibo SO , Jude EB , Tarawneh I. , Nguyen HC , Harkless LB , Boulton AJ A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas wound classification systems. Diabetes Care. 2001;24:84-88.

Younes NA , Albsoul AM The DEPA scoring system and its correlation with the healing rate of diabetic foot ulcers. J Foot Ankle Surg. 2004;43:209-213.

Strauss MB , Aksenov IV Evaluation of diabetic wound classifications and a new wound score. Clin Orthop Relat Res. 2005;439:79-86.

Ince P. , Abbas ZG , Lutale JK et al. Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents. Diabetes Care. 2008;31:964-967.

Beckert S. , Witte M. , Wicke C. , Konigsrainer A. , Coerper S. A new wound-based severity score for diabetic foot ulcers: A prospective analysis of 1,000 patients. Diabetes Care. 2006;29:988-992.

Strauss MB , Aksenov IV Evaluation of diabetic wound classifications and a new wound score. Clin Orthop Relat Res. 2005;439:79-86.

Schaper NC Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies. Diabetes Metab Res Rev. 2004;20(Suppl 1):S90-S95.

10.

Widatalla AH , Mahadi SI , Shawer MA , Elsayem SH , Ahmed ME Implementation of diabetic foot classification system for research purpose to predict lower extremity amputations. Int J Diab Dev Ctries. 2009;29:1-5.

11.

Martinez-De Jesus FR , Ramos-De la MA , Remes-Troche JM , et al. Efficacy and safety of neutral pH superoxidised solution in severe diabetic foot infections. Int Wound J. 2007;4:353-362.

12.

Chipchase SY , Treece KA , Pound N. , Game FL , Jeffcoate WJ Heel ulcers don’t heal in diabetes Or do they? . Diabet Med. 2005;22:1258-1262.

13.

Younes NA , Albsoul AM , Awad H. Diabetic heel ulcers: a major risk factor for lower extremity amputation. Ostomy Wound Manage. 2004;50:50-60.

14.

Perell KL , Merrill V. , Nouvong A. Location of plantar ulcerations in diabetic patients referred to a Department of Veterans Affairs podiatry clinic. J Rehabil Res Dev. 2006;43:421-426.

15.

Isakov E. , Budoragin N. , Shenhav S. , Mendelevich I. , Korzets A. , Susak Z. Anatomic sites of foot lesions resulting in amputation among diabetics and non-diabetics. Am J Phys Med Rehabil. 1995 ;74:130-133.

16.

Shone A. , Burnside J. , Chipchase S. , Game F. , Jeffcoate W. Probing the validity of the probe-to-bone test in the diagnosis of osteomyelitis of the foot in diabetes. Diabetes Care. 2006 ;29:945.

17.

Marston WA Risk factors associated with healing chronic diabetic foot ulcers: the importance of hyperglycemia. Ostomy Wound Manage. 2006 ;52:26-28, 30, 32.

18.

Armstrong DG , Nguyen HC Improvement in healing with aggressive edema reduction after debridement of foot infection in persons with diabetes. Arch Surg. 2000;135:1405-1409.

19.

Vanwijck R. Surgical biology of wound healing. Bull Mem Acad R Med Belg . 2001;156:175-184.

20.

Acosta JB , del Barco DG , Vera DC , et al. The pro-inflammatory environment in recalcitrant diabetic foot wounds. Int Wound J. 2008;5:530-539.

21.

Jeffcoate WJ , Game F. , Cavanagh PR The role of pro-inflammatory cytokines in the cause of neuropathic osteoarthropathy (acute Charcot foot) in diabetes. Lancet. 2005;366:2058-2061.

22.

Fife CE , Smart DR , Sheffield PJ , Hopf HW , Hawkins G. , Clarke D. Transcutaneous oximetry in clinical practice: consensus statements from an expert panel based on evidence. Undersea Hyperb Med. 2009;36:43-53.

23.

Lavery LA , Armstrong DG , Murdoch DP , Peters EJ , Lipsky BA Validation of the Infectious Diseases Society of America’s diabetic foot infection classification system. Clin Infect Dis. 2007;44:562-565.