Developing and Validating a Risk Score for Lower-Extremity Amputation in Patients Hospitalized for a Diabetic Foot Infection

Lipsky, Benjamin A.; Weigelt, John A.; Sun, Xiaowu; Johannes, Richard S.; Derby, Karen G.; Tabak, Ying P.

doi:10.2337/dc11-0331

Cited by 100 publications

(122 citation statements)

References 21 publications

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“…This suggests that low levels of education and income combined with a long duration of T2DM contribute to the eventual development of infected, diabetic foot ulcers and the deterioration of the patient’s quality of life. These results are similar to those reported in other studies [26–32]. …”

Section: Discussionsupporting

confidence: 93%

Clinical and surgical characteristics of infected diabetic foot ulcers in a tertiary hospital of Mexico

Cervantes-García

Salazar-Schettino

2017

Diabetic Foot & Ankle

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Background: The objective of this study was to determine the clinical and surgical characteristics of diabetic foot ulcers in a tertiary level hospital in Mexico. Methods: We performed a longitudinal, descriptive study from July, 2012 to August, 2015 on a sample composed of 100 patients with type 2 diabetes mellitus and infected diabetic foot ulcers. We analyzed socio-demographic variables, comorbidities, characteristics of ulcers, and the applied treatment. Results: We found that the most affected areas were the forefoot (48%) and the plantar region (55%) of the foot. Also, most of the patients arrived with advanced stages of diabetic foot ulcers, since 93% of the lesions were of grades III–V according to the Wagner classification. Moreover, lesions usually present with advanced states of infection, since 60% of the lesions were of grades 3–4 in the PEDIS scale. In addition, the great majority of the patients are prone to complications because we found that 43% of the patients suffered from hypertension, 47% of the patients had chronic kidney disease, and 45% reported smoking. In fact, 45% of the patients eventually suffered an amputation. We also found that the situation is more difficult because the great majority of the patients (96%) have a low level of education and very low income and they do not have any health insurance. Nevertheless, we also found that an efficient treatment can help in avoiding amputations, since 53% of grade IV and 25% of grade V lesions according to the Wagner system did not suffer an amputation. Conclusions: Therefore, an effective antibiotic treatment and an education of the patient on the adequate care of their lesions are essential in increasing the welfare of patients, especially when they have a low level of education.

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Section: Discussionsupporting

confidence: 93%

Clinical and surgical characteristics of infected diabetic foot ulcers in a tertiary hospital of Mexico

Cervantes-García

Salazar-Schettino

2017

Diabetic Foot & Ankle

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“…Previously published studies that have aimed to identify independent risk factors for lower-extremity amputation in patients with a DFI have noted an association with older age (5,22), the presence of fever (5), elevated acute-phase reactants (5,22,23), higher HbA 1c levels (24), and renal insufficiency (5,22). In the current study, we identified the following independent risk factors for lower-extremity amputation in patients with an infected diabetic foot ulcer (in decreasing order of HR): positive probeto-bone test, deep ulcer, elevated CRP levels, and the presence of periwound or pretibial edema.…”

Section: Conclusion Independent Risk Factors For Amputationmentioning

confidence: 99%

“…Patients with a DFI have a 50-fold increased risk of hospitalization and 150-fold increased risk of lowerextremity amputation compared with patients with diabetes and no foot infection (3). Among patients with a DFI, ;5% will undergo a major amputation and 20-30% a 1 minor amputation, with the presence of peripheral arterial disease (PAD) greatly increasing amputation risk (4)(5)(6). Furthermore, lower-limb amputation is associated not only with significant morbidity and mortality but also with major psychosocial and financial consequences (7)(8)(9).…”

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confidence: 99%

Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer

et al. 2015

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OBJECTIVEInfection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation. RESEARCH DESIGN AND METHODSWe prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries. RESULTSAmong these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity of infection also independently predicted amputation. We developed a risk score for any amputation and for amputations excluding the lesser toes (including the variables sex, pain on palpation, periwound edema, ulcer size, ulcer depth, and peripheral arterial disease) that predicted amputation better than the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively). CONCLUSIONSFor individuals with an infected diabetic foot ulcer, we identified independent predictors of amputation, validated the prognostic value of the IWGDF classification system, and developed a new risk score for amputation that can be readily used in daily clinical practice. Our risk score may have better prognostic accuracy than the IWGDF system, the only currently available system, but our findings need to be validated in other cohorts.Infection is a frequent complication of diabetic foot ulcers, with up to 58% of ulcers being infected at initial presentation at a diabetic foot clinic, increasing to 82% in patients hospitalized for a diabetic foot ulcer (1). These diabetic foot infections (DFIs) are associated with poor clinical outcomes for the patient and high costs for both the patient and the health care system (2). Patients with a DFI have a 50-fold increased risk of hospitalization and 150-fold increased risk of lowerextremity amputation compared with patients with diabetes and no foot infection (3). Among patients with a DFI, ;5% will undergo a major amputation and 20-30% a

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“…After a first LEA, up to 50% of patients require another amputation within 3-5 years. Furthermore, the 5-year mortality after LEA is approximately 50%, with the risk considerably higher for diabetic compared with nondiabetic patients [4].…”

Section: Introductionmentioning

confidence: 99%

Knowledge, Practice, and Barriers of Foot Care among Diabetic Patients Attending Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

Seid

Tsige

2015

Advances in Nursing

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Introduction. Diabetes mellitus is a chronic debilitating condition characterized by an increased blood glucose level and is associated with significant morbidity, mortality, and increasing health care cost. Diabetic foot ulcers and lower extremity amputations are a common, complex, costly, and disabling complication of diabetes. An estimated 15% of patients with diabetes develop a lower extremity ulcer. Objective. The aim of this study was to assess knowledge, practice, and barriers of diabetic foot self-care among diabetic patients attending Felege Hiwot Referral Hospital. Method. Institution based descriptive cross-sectional study was conducted on 313 diabetic patients using convenient sampling technique. Furthermore, descriptive statistics and binary and multivariate logistic regression were employed to assess the predicators of knowledge and practice of diabetic foot care. Result. Majority of respondents were males (64.9%). The mean age was 39.1 ± 16. The mean knowledge score was 7.5 ± 2.02 of which 56.2% and 43.8% had good and poor knowledge of foot care, respectively. The mean practice score was 25.2 ± 6.466 of which 53.0% had good and the remaining 47.0% had poor foot care practice. Of 162 respondents having barriers, 56.8% reported "poor communication between patients and health care providers, " 50.6% cited "I did not know what to do, " and 44.4% responded "inconveniency for work" as barriers of foot care. Conclusion and Recommendation. Knowledge and practice of foot care of diabetic patients are still substandard. Poor communication between patients and nurses/physicians, lack of adequate knowledge, and inconveniency for work were commonly cited barriers of foot care. Policy makers should initiate interventional foot care education program throughout the regional state. The study hospital should consider establishing a specialized diabetic clinic in which foot care education can easily be integrated into follow-up care.

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Developing and Validating a Risk Score for Lower-Extremity Amputation in Patients Hospitalized for a Diabetic Foot Infection

Cited by 100 publications

References 21 publications

Clinical and surgical characteristics of infected diabetic foot ulcers in a tertiary hospital of Mexico

Clinical and surgical characteristics of infected diabetic foot ulcers in a tertiary hospital of Mexico

Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer

Knowledge, Practice, and Barriers of Foot Care among Diabetic Patients Attending Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

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