A Comparison of Two Diabetic Foot Ulcer Classification SystemsThe Wagner and the University of Texas wound classification systemsOBJECTIVE -In this study, the following two ulcer classification systems were applied to new foot ulcers to compare them as predictors of outcome: the Wagner (grade) and the University of Texas (UT) (grade and stage) wound classification systems.RESEARCH DESIGN AND METHODS -Ulcer size, appearance, clinical evidence of infection, ischemia, and neuropathy at presentation were recorded, and patients were followed up until healing or for 6 months.RESULTS -Of 194 patients with new foot ulcers, 67.0% were neuropathic, 26.3% were neuroischemic, 1.0% were ischemic, and 5.7% had no identified underlying factors. Median (interquartile range [IQR]) ulcer size at presentation was 1.5 cm 2 (0.6-4.0). Lower-limb amputations were performed for 15% of ulcers, whereas 65% healed [median (IQR) healing time 5 (3-10) weeks] and 16% were not healed at study termination; 4% of patients died. Wagner grade (P Ͻ 0.0001), and UT grade (P Ͻ 0.0001) and stage (P Ͻ 0.001) showed positive trends with increased number of amputations. For UT stage, the risk of amputation increased with infection both alone (odds ratio [OR] = 11.1, P Ͻ 0.0001) and in combination with ischemia (OR = 14.7, P Ͻ 0.0001), but not significantly with ischemia alone (OR = 4.6, P = 0.09). Healing times were not significantly different for each grade of the Wagner (P = 0.1) or the UT system (P = 0.07), but there was a significant stepwise increase in healing time with each stage of the UT system (P Ͻ 0.05), and stage predicted healing (P Ͻ 0.05).CONCLUSIONS -Increasing stage, regardless of grade, is associated with increased risk of amputation and prolonged ulcer healing time. The UT system' s inclusion of stage makes it a better predictor of outcome.

Ulcer area, a measure of ulcer size, predicts the outcome of foot ulcers. Its inclusion into a diabetic wound classification system will make that system a better predictor of outcome.

The objective of this study was to evaluate a number of inner glove liners used to protect the skin from latex proteins and chemical skin sensitizer found in gloves. A battery of performance tests were used for evaluating the inner gloves. Besides these, objective measurements such as skin temperature, skin conductance, and skin moisture content were measured. A series of subjective discomfort/comfort measures were also taken. Seventeen health care providers participated in this experiment where four liner conditions were evaluated at two temperatures. Some of the measures were recorded before and after the tests, while some other measures were recorded every fifteen minutes. Thus each subject participated in eight trials (4 liners X 2 temperatures). The tests were of two hours duration. Sweat, pegboard test, and discomfort measures were the best discriminators of liners, while the other subjective and objective measures were not.