Assessment of Simple Bedside Wound Characteristics for a Prediction Model for Diabetic Foot Ulcer Outcomes

Abstract

Background: Evidence-based learning systems built on prediction models can support wound care community nurses (WCCNs) during diabetic foot ulcer care sessions. Several prediction models in the area of diabetic foot ulcer healing have been developed, most built on cardiovascular measurement data. Two other data types are patient information (i.e. sex and hemoglobin A1c) and wound characteristics (i.e. wound area and wound duration); these data relate to the status of the diabetic foot ulcer and are easily accessible for WCCNs. The aim of the study was to assess simple bedside wound characteristics for a prediction model for diabetic foot ulcer outcomes. Method: Twenty predictor variables were tested. A pattern prediction model was used to forecast whether a given diabetic foot ulcer would (i) increase in size (or not) or (ii) decrease in size. Sensitivity, specificity, and area under the curve (AUC) in a receiver-operating characteristics curve were calculated. Results: A total of 162 diabetic foot ulcers were included. In combination, the predictor variables necrosis, wound size, granulation, fibrin, dry skin, and age were most informative, in total an AUC of 0.77. Conclusions: Wound characteristics have potential to predict wound outcome. Future research should investigate implementation of the prediction model in an evidence-based learning system.

Using Case-Based Reasoning in a Learning System: A Prototype of a Pedagogical Nurse Tool for Evidence-Based Diabetic Foot Ulcer Care

“…It should be noted that the six selected variables are those shown to be the best outcome predictors of a given treatment. 21 In other words, if the purpose, for example, had been to find visually similar cases, other variables would probably have been selected.…”

“…A newly published retrospective cohort study showed how variables in the form of on-site wound characteristics or easily accessible information collected during wound care consultations are highly informative when it comes to predicting whether a diabetic foot ulcer will heal or not. 21 The data and principles used in that study could provide the basis of an evidence-based learning system.…”

“…28,29 Most CBR systems have been applied to classification and treatment choice such as diagnosis and decision support systems, others have been used as planning systems, and a few have been used as tutoring or learning systems. 26,[28][29][30] The aim of this study was to use the CBR methodology and CBR data as well as principles from the retrospective cohort study 21 to build a prototype of an interactive pedagogical tool for evidence-based diabetic foot ulcer care for nurses.…”

How patients interpret early signs of foot problems and reasons for delays in care: Findings from interviews with patients who have undergone toe amputations

“…Many amputations in people with diabetes are thought to be preventable through education, self-management, and ongoing supervision by health care professionals [5]. To prevent amputations, patients must seek care soon after a problem is identified, because small wounds that are treated early are more likely to heal [6]. Untreated wounds are more likely to become infected and require an amputation to prevent spread to contiguous structures.…”

Endovascular surgery for the treatment of purulent and necrotic complications in diabetic foot syndrome

“…One of the severe, formidable complications of DM is diabetic foot syndrome (DFS), together with diabetic retinopathy, nephropathy, neuropathy, and damage to the cardiovascular system. Foot problems occur in a significant number of patients with diabetes, while peripheral arterial lesions occur in 50% of patients with DFS, which is the main cause of poor outcomes in this category of patients ( 1 , 2 ). Progressive deterioration of blood supply to the lower extremities with simultaneous infections associated with wounds and cracks due to various microtraumas of the foot, and insignificant and invisible even for the patient, results in the development of purulent and necrotic complications in the feet, which together with the progression of concomitant diseases, further increases the risk of negative outcomes by increasing the frequency of high amputations of the limbs due to gangrene at the level of the foot, lower leg, and thigh ( 3 - 5 ).…”