Costs and duration of care for lower extremity ulcers in patients with diabetes

Holzer, Susan E. Sedory; Camerota, A.; Martens, Leon G.; Cuerdon, Tim; Crystal-Peters, Jodi; Zagari, Martin

doi:10.1016/s0149-2918(98)80044-1

Cited by 174 publications

(27 citation statements)

References 17 publications

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“…4͑a͒. It consisted of a 30ϫ 60ϫ 110 mm 3 parallelepiped, within which three regions can be identified: A bone, a region representing the in-development pressure ulcer, and the surrounding healthy tissues. The bone, of 10 mm in diameter, was a sample from the forward limb of a dog.…”

Section: Pressure Ulcer Mimicking Phantommentioning

confidence: 99%

“…2 As life expectancy increases in western countries, this disease becomes a growing issue and represents a considerable burden to the society in terms of health care and associated cost. 3,4 Despite these numbers, techniques for prevention and detection of pressure ulcer still remain very limited. For instance, risk scales do exist but they are mostly used for hospitalized patients, and their efficiency is largely questioned.…”

Section: Introductionmentioning

confidence: 99%

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On the potential of ultrasound elastography for pressure ulcer early detection

et al. 2011

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published xx xx xxxx͒ Purpose: Pressure ulcers are areas of soft tissue breakdown induced by a sustained mechanical stress that damages the skin and underlying tissues. They represent a considerable burden to the society in terms of health care and cost. Yet, techniques for prevention and detection of pressure ulcers still remain very limited. In this article, the authors investigated the potential of ultrasound elastography for pressure ulcer early detection. Elastography is an imaging technique providing local information on biological tissue mechanical properties. It is relevant for pressure ulcer detection as this pathology is associated with a gradual stiffening of damaged tissues, beginning in the deeper tissues and progressing toward the skin surface. Methods: A 2D ultrasound elastography method was proposed and its ability in terms of pressure ulcer detection was validated through numerical simulations and physical acquisitions on pressure ulcer mimicking phantoms. In vivo experiments on a rat model are also reported. A maintained pressure was applied on the animal thigh, with a view to generate a pressure ulcer, and ultrasound data were acquired and processed before and after application of this pressure. Results: Numerical simulations demonstrated that a pressure ulcer can theoretically be detected at a very early stage with ultrasound elastography. Even when the ulcer region was characterized by a low stiffening ͑ratio of 1.8 relative to normal tissues͒, the corresponding elastogram clearly underlined the pathological area. This observation was confirmed by the results obtained on a physical phantom mimicking a pressure ulcer at an early stage. Computed elastograms showed strain differences between areas mimicking healthy and pathological tissues. Results corresponding to in vivo experiments revealed a difference in the way tissues behaved before and after the pressure was applied on the animal thigh, which strongly suggests the presence of a pathological area. Conclusions: Experiments demonstrated that ultrasound elastography is a promising technique for pressure ulcer detection, especially at an early stage of the pathology, when the disease is still visually undetectable. In the absence of any gold standard method, this is also a first step toward the development of a quantitative technique.

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Section: Pressure Ulcer Mimicking Phantommentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

On the potential of ultrasound elastography for pressure ulcer early detection

et al. 2011

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“…Foot ulcers, once they have occurred, are frequently recurrent. Holzer et al [12]reported that approximately 2–3% of the diabetic population will develop a foot ulcer each year, and that up to 15% of diabetic patients will develop a chronic foot ulcer during their lifetime. Lower limb amputations will be performed in 60 out of every 10,000 diabetic patients and 70–90% of all amputations are preceded by a lower limb ulcer.…”

Section: Diabetic Peripheral Neuropathies and Their Associated Symptomsmentioning

confidence: 99%

“…A more recent study from the USA [12]assessed the economic costs for diabetic foot ulcers from a database of 3.7 million individuals. A total of 59,000 diabetics were assessed retrospectively over a 2-year period (1991–1992).…”

Section: Economic Burden Of Diabetic Neuropathiesmentioning

confidence: 99%

Diabetic Peripheral Neuropathies: Their Cost to Patient and Society and the Value of Knowledge of Risk Factors for Development of Interventions

Thomas

1999

Eur Neurol

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Diabetic peripheral neuropathies are a variety of syndromes which affect sensory, autonomic and motor nerve function. The commonest form, distal symmetric sensory polyneuropathy, is a major risk factor for foot ulceration, which may eventually lead to lower limb amputation. By 2010, it is estimated that globally 220 million people will have diabetes, and epidemiological studies estimate that more than 50% of diabetic patients with a 25-year history will develop diabetic peripheral neuropathies. In 1986, the USA expenditure for care of these neuropathies was estimated at $240 million, and, as the incidence of diabetes is predicted to increase, this cost is likely to escalate. Risk factors associated with diabetic peripheral neuropathy need to be identified so that interventions can be devised. Recombinant nerve growth factor, a putative treatment for diabetic peripheral neuropathies, is currently being evaluated in phase III trials for this indication.

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“…Sedory Holzer and colleagues estimated that the average cost of an uncomplicated DFU was approximately $13,000, and the cost of a limb amputation was almost $77,000 in 2012. 10 The average length of hospital stay for patients with a DFU was 59% longer than for diabetic patients without ulcers, mostly because of the need for amputations. 6 Approximately 85% of lower-extremity amputations in patients with diabetes are preceded by a DFU.…”

mentioning

confidence: 99%