Outcomes and prognosis of diabetic foot ulcers treated by an interdisciplinary team in Canada

Abstract

The aim of this study was to determine the wound healing outcomes of patients with a plantar diabetic foot ulcer (DFU) treated with an interdisciplinary team approach, and to identify associated variables. A retrospective observational cohort study of 140 adult patients, with a plantar DFU, treated between 2012 and 2018 at a wound care clinic of a University affiliated hospital was conducted. Predictive and explicative analyses were conducted with logistic multivariate methods and with a Receiver Operating Characteristics curve. The best predictor of wound healing at 3 months was a 41.8% wound size reduction at 4 weeks (AUC: 0.86; sensitivity: 83.1%; specificity: 67.2%, positive predictive value: 72.8%; negative predictive value: 78.9%; positive and negative likelihood ratios: 2.53 and 0.25, respectively). Main baseline variables independently associated with this predictor were: a monophasic Doppler waveform (OR 7.52, 95% CI [2.64-21.39]), cigarette smoking (OR 4.7, 95% CI [1.44-15.29]), and male gender (OR 3.58, 95% CI [1.30-9.87]). The health care provider should be cautious and intensify its management of DFUs particularly with patients of male gender; smoking, having a monophasic waveform with a hand-held Doppler, and not achieving a minimal 41.8% wound area reduction at 4 weeks of treatment.

Utilizing a Comprehensive Wound Care Team to Lower Hospital-Acquired Pressure Injuries in an Academic Public Hospital

“…The wound care team continues to assess benchmarks on the national and peer hospital levels, modifying and improving protocols as necessary. The findings of this study are similar to other studies,28,29 demonstrating that the implementation of a comprehensive wound care team reduces the incidence of HAPIs and improves knowledge of care teams regarding management of these injuries. An example protocol and competency list are provided in Figures 11 and 12.…”

Wound healing and healing process in patients with diabetic foot ulcers: A survival analysis study

“…Recently, in a study conducted with 140 patients, the authors found that only 18.6% of DFUs had healed at the four weeks of follow-up; 50.7% at the 3-month follow-up; and 77.9% at 1-year [41]. Although Patryś et al [42] study sample characteristics are similar to the sample analyzed in this study, it is difficult to compare healing rates between studies due to the wide variation in ulcer measurements, definitions, and characteristics.…”

Prognostic factors for delayed healing of complex wounds in adults: A scoping review

“…We include DFU (Wound, Ischaemia, and foot Infection—the WIfI classification grade I or higher or another classification system), VLU (C6 of Clinical‐Aetiology‐Anatomy‐Pathophysiology—the CEAP classification or other classification system that considers wound interruption in the skin barrier), lower extremity arterial disease (LEAD) with critical limb‐threatening ischaemia (CLTI) formerly designated by Critical Limb Ischaemia 18 (with an open wound, Rutherford classification 5 to 6, or Fontaine classification IV) and PU/I (category/stage 2 or higher of Pressure Injury Staging System). We consider DFU, VLU, CLTI and PU/I that do not heal or do not reduce 20 to 50% (<50% DFU, <40% VLU and 20–40% PU/I) in size in 4 weeks or 30 days with an appropriate treatment 4,19,20 …”

“…We consider DFU, VLU, CLTI and PU/I that do not heal or do not reduce 20 to 50% (<50% DFU, <40% VLU and 20-40% PU/I) in size in 4 weeks or 30 days with an appropriate treatment. 4,19,20 We assume healed wounds when the area is equal to 0 cm 2 , 0 mm 2 or complete epithelialization, although the FDA recommendation is "Complete wound closure is defined as skin reepithelialization without drainage or dressing requirements confirmed at two consecutive study visits 2 weeks apart", 16,21 but it was difficult to obtain this information in studies.…”