Evaluating a Risk Score for Lower Extremity Amputation in Patients with Diabetic Foot Infections

Chetpet, Akash; Dikshit, Bharat; Phalgune, Deepak

doi:10.7860/jcdr/2018/36712.12214

Cited by 5 publications

(22 citation statements)

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“…For the ABI, a threshold of ≥0.9 was used in 4 studies investigating the prognostic capacity of the test for DFU healing and healing after minor amputation 31,34,36,40 and <0.9 in 3 studies investigating this for probability of major or any amputation. 22,31,39 For wound healing, an ABI ≥0.9 did not increase the pretest probability of the outcome (PLR 1.06-1.67). For the outcome of amputation, 2 of 3 studies demonstrated no increase in the pretest probability of minor or major amputation with an ABI <0.9 (PLR1.3, 1.1).…”

Section: Discussionmentioning

confidence: 93%

“…25,26,28,38,39 One study examined ABI in those undergoing any amputation. 22 Another study assessed predictive capacity of ankle pressure and toe pressure for amputation where the amputation level was not defined. 17 For the outcome of any amputation using a threshold of ≤0.90 or ≥1.30, Chepet et al 22 reported a PLR of 2.3 and NLR more than 0.5 suggesting that the test did not differentiate those who were not likely to have an amputation from those who were.…”

Section: Major Amputationmentioning

confidence: 99%

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Performance of non‐invasive bedside vascular testing in the prediction of wound healing or amputation among people with foot ulcers in diabetes: A systematic review

Chuter

Schaper

Hinchliffe

et al. 2023

Diabetes Metabolism Res

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IntroductionThe presence of peripheral artery disease (PAD) confers a significantly increased risk of failure to heal and major lower limb amputation for people with diabetes‐related foot ulcer (DFU). Determining performance of non‐invasive bedside tests for predicting likely DFU outcomes is therefore key to effective risk stratification of patients with DFU and PAD to guide management decisions. The aim of this systematic review was to determine the performance of non‐invasive bedside tests for PAD to predict DFU healing, healing post‐minor amputation, or need for minor or major amputation in people with diabetes and DFU or gangrene.MethodsA database search of Medline and Embase was conducted from 1980 to 30 November 2022. Prospective studies that evaluated non‐invasive bedside tests in patients with diabetes, with and without PAD and foot ulceration or gangrene to predict the outcomes of DFU healing, minor amputation, and major amputation with or without revascularisation, were eligible. Included studies were required to have a minimum 6‐month follow‐up period and report adequate data to calculate the positive likelihood ratio (PLR) and negative likelihood ratio for the outcomes of DFU healing, and minor and major amputation. Methodological quality was assessed using the Quality in Prognosis Studies tool.ResultsFrom 14,820 abstracts screened 28 prognostic studies met the inclusion criteria. The prognostic tests evaluated by the studies included: ankle‐brachial index (ABI) in 9 studies; ankle pressures in 10 studies, toe‐brachial index in 4 studies, toe pressure in 9 studies, transcutaneous oxygen pressure (TcPO2) in 7 studies, skin perfusion pressure in 5 studies, continuous wave Doppler (pedal waveforms) in 2 studies, pedal pulses in 3 studies, and ankle peak systolic velocity in 1 study. Study quality was variable. Common reasons for studies having a moderate or high risk of bias were poorly described study participation, attrition rates, and inadequate adjustment for confounders. In people with DFU, toe pressure ≥30 mmHg, TcPO2 ≥25 mmHg, and skin perfusion pressure of ≥40 mmHg were associated with a moderate to large increase in pretest probability of healing in people with DFU. Toe pressure ≥30 mmHg was associated with a moderate increase in healing post‐minor amputation. An ABI using a threshold of ≥0.9 did not increase the pretest probability of DFU healing, whereas an ABI <0.5 was associated with a moderate increase in pretest probability of non‐healing. Few studies investigated amputation outcomes. An ABI <0.4 demonstrated the largest increase in pretest probability of a major amputation (PLR ≥10).ConclusionsPrognostic capacity of bedside testing for DFU healing and amputation is variable. A toe pressure ≥30 mmHg, TcPO2 ≥25 mmHg, and skin perfusion pressure of ≥40 mmHg are associated with a moderate to large increase in pretest probability of healing in people with DFU. There are little data available evaluating the prognostic capacity of bedside testing for healing after minor amputation or for major amputation in people with DFU. Current evidence suggests that an ABI <0.4 may be associated with a large increase in risk of major amputation. The findings of this systematic review need to be interpreted in the context of limitations of available evidence, including varying rates of revascularisation, lack of post‐revascularisation bedside testing, and heterogenous subpopulations.

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Section: Discussionmentioning

confidence: 93%

Section: Major Amputationmentioning

confidence: 99%

Performance of non‐invasive bedside vascular testing in the prediction of wound healing or amputation among people with foot ulcers in diabetes: A systematic review

Chuter

Schaper

Hinchliffe

et al. 2023

Diabetes Metabolism Res

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“…Certainty of the evidence: Very low, based on a single study at high risk of bias and reporting only healing at 4 weeks. Summary of the literature: The score proposed by Chetpet and colleagues, in 2018, 14 comprises 13 scored items (with variable points attributed to each variable) and provides a score that can range from 3 to 41 points, with higher scores representing a poorer prognosis (see Table 2). The authors aimed to develop a score to predict the risk of amputation specifically in people with DFU.…”

Section: Bates Jensen Wound Assessment Tool (Bwat)mentioning

confidence: 99%

Classification of foot ulcers in people with diabetes: A systematic review

Monteiro‐Soares

Hamilton

Russell

et al. 2023

Diabetes Metabolism Res

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BackgroundClassification and scoring systems can help both clinical management and audit the outcomes of routine care.AimThis study aimed to assess published systems used to characterise ulcers in people with diabetes to determine which should be recommended to (a) aid communication between health professionals, (b) predict clinical outcome of individual ulcers, (c) characterise people with infection and/or peripheral arterial disease, and (d) audit to compare outcomes in different populations. This systematic review is part of the process of developing the 2023 guidelines to classify foot ulcers from the International Working Group on Diabetic Foot.MethodsWe searched PubMed, Scopus and Web of Science for articles published up to December 2021 which evaluated the association, accuracy or reliability of systems used to classify ulcers in people with diabetes. Published classifications had to have been validated in populations of >80% of people with diabetes and a foot ulcer.ResultsWe found 28 systems addressed in 149 studies. Overall, the certainty of the evidence for each classification was low or very low, with 19 (68%) of the classifications being assessed by ≤ 3 studies. The most frequently validated system was the one from Meggitt‐Wagner, but the articles validating this system focused mainly on the association between the different grades and amputation. Clinical outcomes were not standardized but included ulcer‐free survival, ulcer healing, hospitalisation, limb amputation, mortality, and cost.ConclusionDespite the limitations, this systematic review provided sufficient evidence to support recommendations on the use of six particular systems in specific clinical scenarios.

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“…The diagnosis of Diabetes mellitus was based on Fasting Plasma Glucose of 126 mg/dl (7.00 mmol/L) or higher, Hb A 1C of 6.5% or higher and 2-hour value of Oral Glucose Tolerance test of 200 mg/dl (11.1 mmol/L) or higher is defined as diabetes [16,17].…”

Section: Inclusion Criteriamentioning

confidence: 99%

“…Glycosylated hemoglobin (HbA1c) was analyzed by high-performance liquid chromatography (HPLC Liaquat University) Research Center laboratory. Subjects were classified into three groups based on serum glycosylated hemoglobin (HbA1c) levels into <7%, 7% to 9.9% and > 10% [16].…”

Section: Hba1cmentioning

confidence: 99%

Risk Categorization of Diabetic Foot in Patients with Type-II Diabetes and Relationship of Various Risk Factors with Risk Categories of Diabetic Foot

Ameer

2020

JAMMR

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Background: Diabetes is the leading cause of nontraumatic amputation. Foot screening which detects and stratification of diabetics which are at the risk of developing diabetic foot ulcer is the simple and useful part of this model of care. Aims: Primary Aim: To stratify patients with type II diabetes into different risk categories of diabetic foot as per International Diabetic Federation guidelines. Secondary Aim: To determine the relationship of various risk factors with risk categories of diabetic foot. Study Design: Cross sectional study. Place and Duration of Study: Department of Medicine, Liaquat University Hospital Jamshoro / Hyderabad from February 2019 to August 2020. Methodology: This study included 117 consecutive patients with confirmed diagnosis of Type-II diabetes of either sex ≥ 18 years of age. Patients fulfilling above criteria were included in study. Feet were thoroughly examined for neuropathy, peripheral vascular disease, infections, ulcers and osteoarthropathy. All the data was recorded on proforma. Patients having normal protective sensations were put in low risk (category 0), those having loss of protective sensations in moderate risk (category 1), those having loss of protective sensations with either high pressure or poor circulation or structural foot deformities or onychomycosis in high risk (category 2) and those having past history of ulceration, amputation or neuropathic fracture were put in very high risk (category 3). Data was analyzed by using SPSS version. 20. Results: Total 117 patients of diabetic foot ulcer were studied, their mean age was 52.28±9.26 years, diabetic duration 10.21±8.10 years and mean HbA1c level was 10.07±1.96 mmol/l. Male were in majority 52.1%. Ulceration history was in 18.8% cases, amputation history was in 7.7% cases, 46 patients (39.3%) had risk category 1. A strong relationship was found between risk categories and age, sex, duration of diabetes, HBA1c. Conclusion: This study revealed that 33 (28%) patients attending the diabetic clinic were at high risk of developing diabetic ulcer.

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Evaluating a Risk Score for Lower Extremity Amputation in Patients with Diabetic Foot Infections

Cited by 5 publications

References 0 publications

Performance of non‐invasive bedside vascular testing in the prediction of wound healing or amputation among people with foot ulcers in diabetes: A systematic review

Performance of non‐invasive bedside vascular testing in the prediction of wound healing or amputation among people with foot ulcers in diabetes: A systematic review

Classification of foot ulcers in people with diabetes: A systematic review

Risk Categorization of Diabetic Foot in Patients with Type-II Diabetes and Relationship of Various Risk Factors with Risk Categories of Diabetic Foot

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