Predictive model of short-term amputation during hospitalization of patients due to acute diabetic foot infections

Barberán, José; Granizo, Juan-José; Aguilar, Lorenzo; Alguacil, Rafael; Sáinz, Felipe; Menendez, M.A.; Giménez, María-José; Martínez, David Andina; Prieto, J

doi:10.1016/j.eimc.2009.12.017

Cited by 18 publications

(27 citation statements)

References 16 publications

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“…Some of the previous studies have reported that the Wagner classification has a strong predictive factor for amputation,13,17,20 which was also concluded by the results of our study.…”

Section: Discussionsupporting

confidence: 91%

Clinical and behavioral factors associated with management outcome in hospitalized patients with diabetic foot ulcer

Yekta¹,

Pourali²,

Nezhadrahim³

et al. 2011

DMSO

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ObjectivesDiabetic foot ulcer (DFU) has been linked to high mortality and morbidity in diabetic patients. In spite of the increasing prevalence of diabetes and its complications, this issue has not been adequately studied in Iran.Materials and methodsIn this cross-sectional study we attempt to describe the prevalence of diabetic foot amputation in patients admitted to our training hospitals in Urmia, Iran, and also to determine the associated demographic, behavioral, and clinical factors.ResultsOf 94 patients with DFU, 34 (32%) had amputation. Those with amputation were significantly older and were also less educated than those without amputation, had longer duration of diabetes (hence were more likely to suffer from complications), and had high-risk wounds plus a poor glycemic control. On logistic regression analysis two variables were associated with amputation: Wagner classification ≥3 and HbA1c. On a receiver operating characteristics curve, the HbA1c cutoff point of 9.7% significantly discriminated to predict increasing risk of amputation.ConclusionBoth glycemic control and promoting the knowledge of patients and health care professionals in order to diagnose DFU in the early stages and to prevent development of the high-grade wounds would be a significant step in reducing the burden of DFU and its effect on quality of life in Iran.

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“…Some of the previous studies have reported that the Wagner classification has a strong predictive factor for amputation,13,17,20 which was also concluded by the results of our study.…”

Section: Discussionsupporting

confidence: 91%

Clinical and behavioral factors associated with management outcome in hospitalized patients with diabetic foot ulcer

Yekta¹,

Pourali²,

Nezhadrahim³

et al. 2011

DMSO

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“…Predictive factors of DFU healing have been studied mainly with simple logistic regression models using one predictor at a time; for example, the effect of wound size (depth, area, and diameter), 7–15 initial treatment response, 10 or the percentage of wound area reduction at 4 weeks. 8 Other predictive factors include the severity of the ulcer grade, 11 , 12 , 16–18 wound duration, 12–14 , 19 wound infection, 15 , 20–22 elevated serum creatinine levels, 20 previous amputation, 21 dialysis, and peripheral arterial disease. 23–26 Previously developed wound scoring systems combine several factors and allocate points to each factor to allow the clinician to estimate healing or amputation likelihood based on an interpretation of the total score, including the lower extremity amputation (LEA) score, 21 the DEPA score, 22 the MAID score, 14 and the American Diabetes Association's DFU risk stratification.…”

Section: Introductionmentioning

confidence: 99%

A Predictive Model for Diabetic Foot Ulcer Outcome: The Wound Healing Index

Fife

Horn

Smout

et al. 2016

Advances in Wound Care

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Objective: To develop a healing index for patients with diabetic foot ulcers (DFUs) for use in clinical practice, research analysis, and clinical trials.Approach: U.S. Wound Registry data were examined retrospectively and assigned a clear outcome (healed, amputated, etc.). Significant variables were identified with bivariate analyses. A multivariable logistic regression model was created based on significant factors (p < 0.05) and tested on a hold-out sample of data. Out of 13,266 DFUs from the original dataset, 6,440 were eligible for analysis. The logistic regression model included 5,239 ulcers, of which 3,462 healed (66.1%). The 10% validation sample utilized 555 ulcers, of which 377 healed (67.9%).Results: Variables that significantly predicted healing were as follows: wound age (duration in days), wound size, number of concurrent wounds of any etiology, evidence of bioburden/infection, patient age, Wagner grade, being nonambulatory, renal dialysis, renal transplant, peripheral vascular disease, and patient hospitalization for any reason.Innovation: We present a validated stratification system, previously described as the Wound Healing Index (WHI), which predicts healing likelihood of patients with DFUs, incorporating patient- and wound-specific variables.Conclusion: The DFU WHI is a comprehensive and user-friendly validated predictive model for DFU healing. It can risk stratify patients enrolled in clinical research trials, stratify patient data for quality reporting and benchmarking activities, and identify patients most likely to require costly therapy to heal.

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“…Barberan and coworkers developed an evaluation sheet containing ten items, with three ranks for each item, creating a record with thirty items to assess foot healing in type II diabetic patients [ 8 ]. The final score ranks the risk range for foot amputation, with the possibility of several outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Each item can be evaluated using three degrees, thus creating grades for each foot examined. Patients were stratified into stages I, II and III, grade III being the worst prognosis [ 8 ]. Despite the enhanced criteria, this classification did not infer a specific percentile for risk of amputation.…”

Section: Introductionmentioning

confidence: 99%

Development of the Tardivo Algorithm to Predict Amputation Risk of Diabetic Foot

et al. 2015

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Diabetes is a chronic disease that affects almost 19% of the elderly population in Brazil and similar percentages around the world. Amputation of lower limbs in diabetic patients who present foot complications is a common occurrence with a significant reduction of life quality, and heavy costs on the health system. Unfortunately, there is no easy protocol to define the conditions that should be considered to proceed to amputation. The main objective of the present study is to create a simple prognostic score to evaluate the diabetic foot, which is called Tardivo Algorithm. Calculation of the score is based on three main factors: Wagner classification, signs of peripheral arterial disease (PAD), which is evaluated by using Peripheral Arterial Disease Classification, and the location of ulcers. The final score is obtained by multiplying the value of the individual factors. Patients with good peripheral vascularization received a value of 1, while clinical signs of ischemia received a value of 2 (PAD 2). Ulcer location was defined as forefoot, midfoot and hind foot. The conservative treatment used in patients with scores below 12 was based on a recently developed Photodynamic Therapy (PDT) protocol. 85.5% of these patients presented a good outcome and avoided amputation. The results showed that scores 12 or higher represented a significantly higher probability of amputation (Odds ratio and logistic regression-IC 95%, 12.2–1886.5). The Tardivo algorithm is a simple prognostic score for the diabetic foot, easily accessible by physicians. It helps to determine the amputation risk and the best treatment, whether it is conservative or surgical management.

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Predictive model of short-term amputation during hospitalization of patients due to acute diabetic foot infections

Cited by 18 publications

References 16 publications

Clinical and behavioral factors associated with management outcome in hospitalized patients with diabetic foot ulcer

Clinical and behavioral factors associated with management outcome in hospitalized patients with diabetic foot ulcer

A Predictive Model for Diabetic Foot Ulcer Outcome: The Wound Healing Index

Development of the Tardivo Algorithm to Predict Amputation Risk of Diabetic Foot

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