Validation of diabetic foot classifications in Argentina
DOI:
https://doi.org/10.47196/diab.v57i2.625Keywords:
diabetic foot, classifications, amputation, mortalityAbstract
Introduction: the classifications in diabetic foot (DF) are a tool that aims to improve communication between professionals, referral and counter-referral, provide a prognosis, help in the assessment of lesions, and contribute to statistical purposes.
Objectives: to describe the characteristics of patients who presented to the clinic or emergency department with DF over a period of 3 months, determine the risk according to 5 classifications (Texas, IDSA, SEWSS, WIfI, and SINBAD), and evaluate their evolution at 6 months in relation to the severity degree determined by each classification.
Materials and methods: 312 patients from 15 institutions in Argentina were analyzed. The Diabetic Foot Classification Calculator/Risk Score from the Diabetic Foot Committee of the Argentina Argentina Diabetes Society was used for the analysis.
Results: 43% of patients (n=133) required hospitalization at the time of the first consultation and 61% (n=189) had previously consulted. The total major amputation percentage was 8.33% (95%CI; 5.5-11.9) (n=26), and the minor amputation percentage was 29.17% (95% CI; 24.2-34.6) (n=91). At 6 months, the death rate was 4.49% (95% CI; 2.5-7.4) (n=14), 24.3% (95% CI; 19.6-29.5) had an open wound (n=76), 58.0% (95% CI; 52.3-66.5) (n=181) had healed, and 7.37% were lost to follow-up (n=23). The SEWSS and WIfI classifications were related to major amputation, healing, and death. Regarding the Texas classification, 49% of patients had a penetrating wound to bone or joint (Texas 3), with or without infection. 65.3% of major amputations and 78.6% of deaths occurred in patients with ischemia. The SEWSS cut-off point for major amputation was 20.
References
I. Vas PRJ, Edmonds M, Kavarthapu V, et al. The diabetic foot attack: Itis too late to retreat! Int J Low Extrem Wounds 2018;17:7-13.
II. Carro G, Saurral R, Witman E. Ataque de pie diabético: descripción fisiopatológica, presentación clínica, tratamiento y evolución. Medicina (B Aires) 2020;80:523-30.
III. Carro G, Saurral R, Salvador-Sagüez F, Witman E, Carrio L, Dituro C, et al. Estudio de diabetes mellitus y pie diabético en la internación: datos de Argentina. Rev Arg Soc Diab 2019;53(1):3-15.
IV. Boulton AJ. The pathway to foot ulceration in diabetes. Med Clin North Am 2013;97:775-790.
V. Armstrong D, Swerdlow M, Armstrong A, Conte M, Padula W, Bus S. Five year mortality and direct costs of care for people with diabetic foot complications comparable to cancer. J Foot Ankle Res 2020;13(1):16.
VI. Carro G, Saurral R, Carlucci E, Gette F, Llanos M, Amato P. A comparison between diabetic foot classifications: WIfI, Saint Elián and Texas. Description of wounds and clinical outcomes. Int J Low Extrem Wounds 2022;21(2):120-130.
VII. Schaper N, van Netten J, Apelqvist J, Bus S, Hinchliffe R, Lipsky B. Practical guidelines on the prevention and management of diabetic foot disease. Diab Metab Res Rev 2020:e3266
VIII. Piaggesi A, Copelli A, Goretti C, Iacopi E, Mattaliano C. Do you want to organize a multidisciplinary diabetic foot clinic? We can help. Int J Low Extrem Wounds 2014;13: 363-70.
IX. Monteiro-Soares M, Russell D, Boyko E, et al. Guidelines on the classification of diabetic foot ulcers (IWGDF 2019) (revisado marzo de 2023). Disponible en: https://iwgdfguidelines.org/wp-content/uploads/2021/01/Monteiro-Soares_et_al-2020-IWGDF-classification-guideline.pdf.
X. Lispky A. Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012;54:e132-73.
XI. Martínez-De Jesús F. A checklist system to score healing progress of diabetic foot ulcers. IJLEW 2010;9:74-83.
XII. Mills J, Conte M, Armstrong D, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on wound, ischemia, and foot infection (WIfI). J VascSurg 2014;59:220-34.e2.
XIII. Armstrong D, Lavery L, Harkless L. Validation of a wound classification system. Diabetes Care 1998;21:855-9.
XIV. Monteiro-Soares M, Boyko E, Jeffcoate W, Mills J, Russell D, Morbach S, et al. Diabetic foot ulcer classifications: a critical review. Diabetes metab Res Rev 2020;36 (51):e3272
XV. Ince P, Abbas Z, Lutale J, Basit A, Mansoor Ali S, Chohan F, et al. Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents. Diabetes Care 2008;31(5):964-967.
XVI. mHealth. Documento de la Organización Mundial de la Salud; 2018. Consultado: marzo de 2023. Disponible en: https://apps.who.int/gb/ebwha/pdf_files/WHA71/A71_20-en.pdf.
XVII. Vainieri E, Ahluwalia R, Slim H, Walton D, Manu C, Taori S, et al. Outcomes after emergency admission with a diabetic foot attack indicate a high rate of healing and limb salvage but increased mortality:18-month follow-up study. Exp Clin Endocrinol Diabetes 2020;128:1-7.
XVIII. Prompers L, Edmonds M, Jude E, et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The Eurodiale study. Diabetología 2008;51:747-55.
XIX. Rigato M, Pizzol D, Tiago A, Putito G, Avogaro A, Fadini G. Characteristics, prevalence and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis. Diabetes Res Clin Pract 2018;142:63-73.
XX. Mathioudakis N, Hicks CW, Canner JK, et al. The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing but not major amputation in patients with diabetic foot ulcers treated in a multidisciplinary setting. J Vasc Surg 2017;65:1698-1705.
XXI. Ward R, Dunn J, Clavijo L, Shavelle D, Rowe V, Woo K. Outcomes of critical limb ischemia in an urban, safety net hospital population with high WIfI risk amputation scores. Ann Vasc Surg 2017;38:84-89.
XXII. Hicks CW, Canner JK, Mathioudakis N, et al. The Society for Vascular Surgery Wound, Ischemia and foot Infection (WIfI) classification independently predicts wound healing in diabetic foot ulcers. J Vasc Surg 2018;68:1096-1106.
XXIII. Weaver M, Hicks C, Canner J, et al. The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing better than direct angiosome perfusion in diabetic foot wounds. J Vasc Surg 2018;68:1473-81.
XXIV. Marzoq A, Shiaa N, Zaboon R, Baghlany Q, Alabbood M. Assessment of the Outcome of Diabetic Foot Ulcers in Basrah, Southern Iraq. A cohort study. Int J Diabetes Metab 2019;25:33-38.
XXV. Bekele F, Chelkeba L, Fekadu G, Bekele K. Risk factors and outcomes of diabetic foot ulcer among diabetes mellitus patients admitted to Nekemte referral hospital, western Ethiopia. Prospective observational study. Ann Med Surg (Lond) 2020;51:17-23.
XXVI. Meloni M, Bouillet B, Ahluwalia R, et al. Validation of the fast-track model: a simple tool to assess the severity of diabetic foot ulcers. J Clin Med 2023;12:761.
XXVII. Huang Y, Xie T, Cao Y, et al. Comparison of two classification systems in predicting the outcome of diabetic foot ulcers: the Wagner grade and the Saint Elián Wound score systems. Wound Repair Regen 2015;23:379-385.
XXVIII. Cull DL, Manos G, Hartley MC, et al. An early validation of the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System. J Vasc Surg 2014;60: 1535-1541.
XXIX. Beropoulis E, Stavroulakis K, Schwindt A, Stachmann A, Torsello G, Bisdas T. Validation of the Wound, Ischemia, foot Infection (WIfI) classification system in non diabetic patients related by endovascular means for critical limb ischemia. J Vasc Surg 2016;64:95-103.
XXX. Darling JD, McCallum JC, Soden PA, et al. Predictive ability for the Society for Vascular Surgery Wound, Ischemia and foot infection (WIfI) classification system after first time lower extremity revascularization. J Vasc Surg 2017;65: 695-704.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 on behalf of the authors. Reproduction rights: Argentine Diabetes Society
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Dirección Nacional de Derecho de Autor, Exp. N° 5.333.129. Instituto Nacional de la Propiedad Industrial, Marca «Revista de la Sociedad Argentina de Diabetes - Asociación Civil» N° de concesión 2.605.405 y N° de disposición 1.404/13.
La Revista de la SAD está licenciada bajo Licencia Creative Commons Atribución – No Comercial – Sin Obra Derivada 4.0 Internacional.
Por otra parte, la Revista SAD permite que los autores mantengan los derechos de autor sin restricciones.
