Monteiro-Soares M, Boyko EJ, Jeffcoate W, Mills JL, Russell D, Morbach S, Game F, et al.
Diabetes/metabolism research and reviews. Date of publication 2020 Mar 1;volume 36 Suppl 1():e3272.
1. Diabetes Metab Res Rev. 2020 Mar;36 Suppl 1:e3272. doi: 10.1002/dmrr.3272.
Diabetic foot ulcer classifications: A critical review.
Monteiro-Soares M(1)(2), Boyko EJ(3), Jeffcoate W(4), Mills JL(5), Russell
D(6)(7), Morbach S(8)(9), Game F(10).
Author information:
(1)Departamento de Medicina da Comunidade, Informação e Decisão em Saúde
(MEDCIDS), Faculdade de Medicina da Universidade do Porto, Oporto, Portugal.
(2)Center for Health Technology and Services Research (CINTESIS), Faculdade de
Medicina da Universidade do Porto, Oporto, Portugal.
(3)VA Puget Sound Health Care System, Seattle, Washington.
(4)Department of Diabetes and Endocrinology, Nottingham University Hospitals NHS
Trust, Nottingham, UK.
(5)Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey
Department of Surgery, Baylor College of Medicine, Houston, Texas.
(6)Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
(7)Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds,
Leeds, UK.
(8)Department of Diabetes and Angiology, Marienkrankenhaus gGmbH, Soest, Germany.
(9)Institute for Health Services Research and Health Economics,
Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
(10)Department of Diabetes and Endocrinology, University Hospitals of Derby and
Burton NHS Foundation Trust, Derby, UK.
Classification and scoring systems can help both clinical management and audit
outcomes of routine care. The aim of this study was to assess published systems
of diabetic foot ulcers (DFUs) to determine which should be recommended for a
given clinical purpose. Published classifications had to have been validated in
populations of > 75% people with diabetes and a foot ulcer. Each study was
assessed for internal and external validity and reliability. Eight key factors
associated with failure to heal were identified from large clinical series and
each classification was scored on the number of these key factors included.
Classifications were then arranged according to their proposed purpose into one
or more of four groups: (a) aid communication between health professionals, (b)
predict clinical outcome of individual ulcers, (c) aid clinical management
decision making for an individual case, and (d) audit to compare outcome in
different populations. Thirty-seven classification systems were identified of
which 18 were excluded for not being validated in a population of >75% DFUs. The
included 19 classifications had different purposes and were derived from
different populations. Only six were developed in multicentre studies, just 13
were externally validated, and very few had evaluated reliability.Classifications
varied in the number (4 - 30), and definition of individual items and the
diagnostic tools required. Clinical outcomes were not standardized but included
ulcer-free survival, ulcer healing, hospitalization, limb amputation, mortality,
and cost. Despite the limitations, there was sufficient evidence to make
recommendations on the use of particular classifications for the indications
listed above.
© 2020 John Wiley & Sons Ltd.
DOI: 10.1002/dmrr.3272
PMID: 32176449 [Indexed for MEDLINE]
