Society for Vascular Surgery Wound, Ischemia, foot Infection (WIfI) score correlates with the intensity of multimodal limb treatment and patient-centered outcomes in patients with threatened limbs managed in a limb preservation center

Robinson, William P.; Loretz, Lorraine; Hanesian, Colleen; Flahive, Julie; Bostrom, John; Lunig, Nicholas; Schanzer, Andres; Messina, Louis M.

doi:10.1016/j.jvs.2017.01.063

Cited by 67 publications

(51 citation statements)

References 14 publications

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“…Meggitt‐Wagner, PEDIS, SINBAD, SEWSS, University of Texas, and WIfI have been externally validated for prediction of both ulcer healing and LEA within cohorts but not at an individual level. Further, validation of WIfI has been largely performed in cohorts of patients with severe limb ischaemia across several continents, with one cohort specific to DFU and five additional papers including >75% patients with DFU …”

Section: Recommendations and Rationalementioning

confidence: 99%

“…Whilst WIfI has not been subject to reproducibility assessment in a DFU cohort, it has impressive reproducibility in a PAD setting . It has been validated in only one cohort exclusively of patients with an active DFU but has been shown in multiple validation studies to predict outcomes relevant to this clinical group such as healing, time to healing, need for revascularisation, LEA, LEA free survival, and mortality . Both need for revascularisation and timing of revascularisation can be guided by the combination of risk estimate for amputation and benefit estimate for revascularisation.…”

Section: Recommendations and Rationalementioning

confidence: 99%

“…3 with DFU. [28][29][30][31][32] PEDIS was originally developed as a descriptive classification for use in research and not designed for prognostic purposes. It does not include patient factors (end-stage renal disease) or either the location or the number of foot ulcers.…”

Section: Recommendationmentioning

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

197

277

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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: Recommendations and Rationalementioning

confidence: 99%

Section: Recommendations and Rationalementioning

confidence: 99%

See 1 more Smart Citation

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

Monteiro‐Soares

Russell

Boyko

et al. 2020

Diabetes Metabolism Res

197

277

View full text Add to dashboard Cite

show abstract

“…In 2015, its internal validation was conducted, showing an association between severity of its components and both time to DFU healing and major LEA occurrence. Since then, five studies have provided external validation of WIfI in populations where at least 75% of subjects had DFUs . Four of them, however, were conducted in the same institution and with a larger population including previously reported participants plus additional participants, which may have the original sample from which the classification was developed …”

Section: Resultsmentioning

confidence: 99%

“…Since then, five studies have provided external validation of WIfI in populations where at least 75% of subjects had DFUs. [60][61][62][63][64] Four of them, however, were conducted in the same institution and with a larger population including previously reported participants plus additional participants, which may have the original sample from which the classification was developed. [60][61][62]64 This classification has been shown to predict multiple pertinent DFU outcomes, including extent of healing, time to heal, LEA occurrence, LEA-free survival, need for revascularization, maintenance of ambulatory and independent living status, costs, and mortality.…”

Section: Van Acker-petermentioning

confidence: 99%

Diabetic foot ulcer classifications: A critical review

Monteiro‐Soares

Boyko

Jeffcoate

et al. 2020

Diabetes Metabolism Res

117

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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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