Clasificaciones de lesiones en pie diabético: Un problema no resuelto

Torre, Héctor González de la; Fernández, Abián Mosquera; Lorenzo, Mikel; Pérez, Estrella Perdomo; Montesdeoca, María del Pino Quintana

doi:10.4321/s1134-928x2012000200006

Cited by 9 publications

(15 citation statements)

References 45 publications

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“…This guideline has been compiled based on our review 3 and following consideration of recent review articles on DFU classification systems. [4][5][6][7][8] To identify factors associated with DFU outcome (healing, hospitalisation, amputation, and mortality), and to select the most pertinent, we searched for reports of large clinical cohorts. 9-15 A consensus was then reached, based upon expert opinion, of eight factors that were consistently and meaningfully related to DFU outcomes that would ideally constitute the basis of a classification system: For determining the quality of evidence, we conducted a review 3 and assessed the presence and number of reliability (namely interobserver agreement) studies and internal and external validation studies for one or more clinical outcomes.…”

Section: Methodsmentioning

confidence: 99%

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Guidelines on the classification of diabetic foot ulcers (IWGDF 2019)

Monteiro‐Soares

Russell

Boyko

et al. 2020

Diabetes Metabolism Res

191

262

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The International Working Group on the Diabetic Foot (IWGDF) has been publishing evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This publication represents a new guideline addressing the use of classifications of diabetic foot ulcers in routine clinical practice and reviews those which have been published. We only consider systems of classification used for active diabetic foot ulcers and do not include those that might be used to define risk of future ulceration. The guidelines are based on a review of the available literature and on expert opinion leading to the identification of eight key factors judged to contribute most to clinical outcomes. Classifications are graded on the number of key factors included as well as on internal and external validation and the use for which a classification is intended. Key factors judged to contribute to the scoring of classifications are of three types: patient related (end‐stage renal failure), limb‐related (peripheral artery disease and loss of protective sensation), and ulcer‐related (area, depth, site, single, or multiple and infection). Particular systems considered for each of the following five clinical situations: (a) communication among health professionals, (b) predicting the outcome of an individual ulcer, (c) as an aid to clinical decision‐making for an individual case, (d) assessment of a wound, with/without infection, and peripheral artery disease (assessment of perfusion and potential benefit from revascularisation), and (d) audit of outcome in local, regional, or national populations. We recommend: (a) for communication among health professionals the use of the SINBAD system (that includes Site, Ischaemia, Neuropathy, Bacterial Infection and Depth); (b) no existing classification for predicting outcome of an individual ulcer; (c) the Infectious Diseases Society of America/IWGDF (IDSA/IWGDF) classification for assessment of infection; (d) the WIfI (Wound, Ischemia, and foot Infection) system for the assessment of perfusion and the likely benefit of revascularisation; and (e) the SINBAD classification for the audit of outcome of populations.

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Section: Methodsmentioning

confidence: 99%

“…This guideline has been compiled based on our review and following consideration of recent review articles on DFU classification systems . To identify factors associated with DFU outcome (healing, hospitalisation, amputation, and mortality), and to select the most pertinent, we searched for reports of large clinical cohorts .…”

Section: Methodsmentioning

confidence: 99%

Guidelines on the classification of diabetic foot ulcers (IWGDF 2019)

Monteiro‐Soares

Russell

Boyko

et al. 2020

Diabetes Metabolism Res

191

262

View full text Add to dashboard Cite

show abstract

“…Other variables (such as LOPS) are not considered, and infected and/or ischaemic DFUs cannot be adequately differentiated by this classification system …”

Section: Resultsmentioning

confidence: 99%

“…These factors were as follows: To identify all the classifications ever used to classify DFUs, it was decided not to conduct a formal systematic review due to the existence of several recent published systematic and nonsystematic reviews with the same purpose as this document. [9][10][11][12][13][14] The most recent of these reviews was published in 2016, so a search was conducted in PubMed using the terms "diabetic foot [Mesh]" and "classification" or "scoring systems" to identify possible classifications that could have been published after 2016. We have also consulted experts inside and outside the group to identify all the classifications ever proposed for DFUs.…”

Section: Methodsmentioning

confidence: 99%

“…Other variables (such as LOPS) are not considered, and infected and/or ischaemic DFUs cannot be adequately differentiated by this classification system. 9,10,13 Several authors consider this classification to be too linear and simplistic, leading to high levels of imprecision. 9,12 Despite its weaknesses, there have been a number of studies that report an association between grade and LEA, 6,18,20,29,[34][35][36][37][38][39][40][41][42] and accuracy measures have also been published (see Table S2).…”

Section: Meggitt-wagnermentioning

confidence: 99%

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Diabetic foot ulcer classifications: A critical review

Monteiro‐Soares

Boyko

Jeffcoate

et al. 2020

Diabetes Metabolism Res

113

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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.

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Uso de apósitos con TLC–NOSF en el manejo de la úlcera de pie diabético, basado en la revisión de la evidencia y la práctica clínica

Sagüez

Gallardo²,

Pozo

2020

J Wound Care

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Sinopsis La incidencia de la úlcera de pie diabético (UPD) ha incrementado en la última década, tanto en Chile como en el mundo, como resultado de un aumento progresivo en la prevalencia de la diabetes mellitus. Frente a esta compleja situación, y dado que las UPD están asociadas con un alto riesgo de infección y amputación, es necesario optar por tratamientos cuya evidencia demuestre efectividad en el manejo de este tipo de úlceras. Un apósito con tecnología lípido coloide y factor nano oligosacárido (TLC–NOSF), con un alto nivel de evidencia, ha demostrado ser efectivo en el manejo local de UPD, y podría ayudar a combatir esta problemática. El objetivo de este artículo es revisar la evidencia en relación con la TLC–NOSF y su implementación en la práctica clínica. Conflicto de interés: FSS recibió pagos personales de Laboratorios UrgoMedical por ponencias y actividades. RCG es empleada de Laboratorios UrgoMedical. APP declara no tener conflicto de interés.

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Clasificaciones de lesiones en pie diabético: Un problema no resuelto

Abstract: Rincón científico COMUNICACIONES Clasificaciones de lesiones en pie diabético. Un problema no resuelto

Cited by 9 publications

References 45 publications

Guidelines on the classification of diabetic foot ulcers (IWGDF 2019)

Guidelines on the classification of diabetic foot ulcers (IWGDF 2019)

Diabetic foot ulcer classifications: A critical review

Uso de apósitos con TLC–NOSF en el manejo de la úlcera de pie diabético, basado en la revisión de la evidencia y la práctica clínica

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