TY - JOUR
T1 - Validation of a diabetic wound classification system
T2 - The contribution of depth, infection, and ischemia to risk of amputation
AU - Armstrong, David G.
AU - Lavery, Lawrence A.
AU - Harkless, Lawrence B.
PY - 1998
Y1 - 1998
N2 - OBJECTIVE - To validate a wound classification instrument that includes assessment of depth, infection, and ischemia based on the eventual outcome of the wound. RESEARCH DESIGN AND METHODS - We evaluated the medical records of 360 diabetic patients presenting for care of foot wounds at a multidisciplinary tertiary care foot clinic. As per protocol, all patients had a standardized evaluation to assess wound depth, sensory neuropathy, vascular insufficiency, and infection. Patients were assessed at 6 months after their initial evaluation to see whether an amputation had been performed. RESULTS - There was a significant overall trend toward increased prevalence of amputations as wounds increased in both depth (χ2(trend) = 143.1, P < 0.001) and stage (χ2(trend) = 91.0, P < 0.001). This was true for every subcategory as well with the exception of noninfected, nonischemic ulcers. There were no amputations performed within this stage during the follow-up period. Patients were more than 11 times more likely to receive a midfoot or higher level amputation if their wound probed to bone (18.3 vs. 2.0%, P < 0.001, χ2 = 31.5, odds ratio (OR) = 11.1, CI = 4.0-30.3). Patients with infection and ischemia were nearly 90 times more likely to receive a midfoot or higher amputation compared with patients in less advanced wound stages (76.5 vs. 3.5%. P < 0.001, χ2 = 133.5, OR = 89.6, CI = 25-316). CONCLUSIONS - Outcomes deteriorated with increasing grade and stage of wounds when measured using the University of Texas Wound Classification System.
AB - OBJECTIVE - To validate a wound classification instrument that includes assessment of depth, infection, and ischemia based on the eventual outcome of the wound. RESEARCH DESIGN AND METHODS - We evaluated the medical records of 360 diabetic patients presenting for care of foot wounds at a multidisciplinary tertiary care foot clinic. As per protocol, all patients had a standardized evaluation to assess wound depth, sensory neuropathy, vascular insufficiency, and infection. Patients were assessed at 6 months after their initial evaluation to see whether an amputation had been performed. RESULTS - There was a significant overall trend toward increased prevalence of amputations as wounds increased in both depth (χ2(trend) = 143.1, P < 0.001) and stage (χ2(trend) = 91.0, P < 0.001). This was true for every subcategory as well with the exception of noninfected, nonischemic ulcers. There were no amputations performed within this stage during the follow-up period. Patients were more than 11 times more likely to receive a midfoot or higher level amputation if their wound probed to bone (18.3 vs. 2.0%, P < 0.001, χ2 = 31.5, odds ratio (OR) = 11.1, CI = 4.0-30.3). Patients with infection and ischemia were nearly 90 times more likely to receive a midfoot or higher amputation compared with patients in less advanced wound stages (76.5 vs. 3.5%. P < 0.001, χ2 = 133.5, OR = 89.6, CI = 25-316). CONCLUSIONS - Outcomes deteriorated with increasing grade and stage of wounds when measured using the University of Texas Wound Classification System.
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U2 - 10.2337/diacare.21.5.855
DO - 10.2337/diacare.21.5.855
M3 - Article
C2 - 9589255
AN - SCOPUS:0031790954
SN - 0149-5992
VL - 21
SP - 855
EP - 859
JO - Diabetes care
JF - Diabetes care
IS - 5
ER -