Assessment of Signs of Foot Infection in Diabetes Patients Using Photographic Foot Imaging and Infrared Thermography

Background Securing an early accurate diagnosis of diabetic foot infections and assessment of their severity are of paramount importance since these infections can cause great morbidity and potentially mortality and present formidable challenges in surgical and antimicrobial treatment. Methods In June 2018, we searched the literature using PuEbMed and EMBASE for published studies on the diagnosis of diabetic foot infection. On the basis of predetermined criteria, we reviewed prospective controlled, as well as noncontrolled, studies in any language, seeking translations for those not in English. We then developed evidence statements on the basis of the included papers. Results From the 4242 records screened, we selected 35 papers that met our inclusion criteria. The quality of all but one of the evidence statements was low because of the weak methodology of nearly all of the studies. The available data suggest that diagnosing diabetic foot infections on the basis of clinical signs and symptoms and classified according to the International Working Group of the Diabetic Foot scheme correlates with the patient's likelihood of ulcer healing, of lower extremity amputation, and risk of death. Elevated levels of selected serum inflammatory markers are supportive, but not diagnostic, of soft tissue or bone infection. In patients with suspected diabetic foot osteomyelitis, both a positive probe‐to‐bone test and an elevated erythrocyte sedimentation rate are strongly associated with its presence. Culturing tissue samples of soft tissues or bone, when care is taken to avoid contamination, provides more accurate microbiological information than culturing superficial (swab) samples. Plain X‐ray remains the first‐line imaging examination when there is suspicion of diabetic foot osteomyelitis, but advanced imaging methods help in cases when either the diagnosis or the localization of infection is uncertain. Conclusion The results of this first reported systematic review on the diagnosis of diabetic foot infections provide some guidance for clinicians, but there is a need for more prospective controlled studies of high quality.

Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Diagnosis of infection in the foot in diabetes: a systematic review

Senneville

Lipsky

Abbas

et al. 2020

“…While two studies suggest that with photographic foot imaging diabetic foot ulcers can be reliably assessed, the diagnosis of abundant callus proves to be moderately reliable and the studies were too small to reliably assess other important signs such as blisters, fissures, and erythema. The same research group showed that the combination of photographic imaging and infrared thermography improves accuracy over a single modality alone in the diagnosis of diabetic foot infection . This is the first time that home‐monitoring approaches for the early diagnosis of foot infection have been presented.…”

Section: Discussionmentioning

confidence: 90%

“…Good feasibility of using the photographic foot imaging device in the home environment was also shown: patient adherence was high, referrals based on photographic assessment justified, and perceived usability was good . The same authors also showed in a cross‐sectional study that diagnosis of foot infection is valid and reliable using photographic imaging in combination with infrared thermography, taking clinical diagnosis as reference (sensitivity >60%, specificity >79%), and better than with using each modality on its own . In two case series, Foltynski et al assessed the feasibility of at‐home use of the TeleDiaFoS system for ulcer monitoring, and included: total number of assessed ulcer pictures, the length of the monitoring period, and change in ulcer area after four and 12 weeks follow‐up .…”

Section: Resultsmentioning

confidence: 99%

Telehealth and telemedicine applications for the diabetic foot: A systematic review

Hazenberg

Stegge

Baal

et al. 2019

Self Cite

Summary The aim of this systematic review is to assess the peer‐reviewed literature on the psychometric properties, feasibility, effectiveness, costs, and current limitations of using telehealth and telemedicine approaches for prevention and management of diabetic foot disease. MEDLINE/PubMed was searched for peer‐reviewed studies on telehealth and telemedicine approaches for assessing, monitoring, preventing, or treating diabetic foot disease. Four modalities were formulated: dermal thermography, hyperspectral imaging, digital photographic imaging, and audio/video/online communication. Outcome measures were: validity, reliability, feasibility, effectiveness, and costs. Sixty‐one studies were eligible for analysis. Three randomized controlled trials showed that handheld infrared dermal thermography as home‐monitoring tool is effective in reducing ulcer recurrence risk, while one small trial showed no effect. Hyperspectral imaging has been tested in clinical settings to assess and monitor foot disease and conflicting results on its diagnostic use show that this method is still in an experimental stage. Digital photography is used to assess and monitor foot ulcers and pre‐ulcerative lesions and was found to be a valid, reliable, and feasible method for telehealth purposes. Audio/video/online communication is mainly used for foot ulcer monitoring. Two randomized controlled trials show similar healing efficacy compared with regular outpatient clinic visits, but no benefit in costs. In conclusion, several technologies with good psychometric properties are available that may be of benefit in helping to assess, monitor, prevent, or treat diabetic foot disease, but in most cases, feasibility, effectiveness, and cost savings still need to be demonstrated to become accepted and used modalities in diabetic foot care.

“…Measures of agreement were described in two studies. Bravo‐Molina et al showed a κ coefficient of 0.574, and Hazenberg et al of 0.44, both indicating moderate agreement between raters who evaluated the same ulcers.…”

Section: Resultsmentioning

confidence: 97%

Diabetic foot ulcer classifications: A critical review

Monteiro‐Soares

Boyko

Jeffcoate

et al. 2020

106

117

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.