Use of the SINBAD Classification System and Score in Comparing Outcome of Foot Ulcer Management on Three Continents

Abstract

OBJECTIVE—To compare populations with and outcomes of diabetic foot ulcers managed in the U.K., Germany, Tanzania, and Pakistan and to explore the use of a new score of ulcer type in comparing outcomes among different countries. RESEARCH DESIGN AND METHODS—Data from a series of 449 patients with diabetic foot ulcers managed in the U.K. were used to evaluate the new simplified system of classification and to derive an aggregate score. The use of the score was then explored using data from series managed in Germany (n = 239), Tanzania (n = 479), and Pakistan (n = 173). RESULTS—A highly significant difference was found in time to healing between ulcers of increasing score in the U.K. series (Kruskal-Wallis test; P = 0). When data from all centers were examined, a step-up in days to healing was noted for those with scores of ≥3 (out of 6). Examination of baseline variables contributing to outcome revealed the following differences among centers: ischemia, ulcer area, and depth contributing to outcome in the U.K.; ischemia, area, depth, and infection in Germany; depth, infection, and neuropathy in Tanzania; and depth alone in Pakistan. CONCLUSIONS—Any system of classification designed for general implementation must encompass all the variables that contribute to outcome in different communities. Adoption of a simple score based on these variables, the Site, Ischemia, Neuropathy, Bacterial Infection, and Depth (SINBAD) score, may prove useful in predicting ulcer outcome and enabling comparison among different centers.

Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers

“…The Condition of the DFU at First Expert Assessment Ulcers that are graded as being more severe have a worse prognosis, and this is the basis of current grading schemes (1,27,28). Recent data have also shown a statistically significant association between ulcer severity and the time to first expert assessment, in both Norway and the U.K. (29,30).…”

Diabetic ulcer severity score: clinical validation and outcome

“…[6][7][8] Paul, et al in a multicenter trial over three continents, found similar finding of mean age of 66.7 years. 9 Graham lee et al in a Scottish study reported a mean age of 67.4 years. 10 National hospital discharge survey, looking at 275,000 inpatient records from 500 hospitals since 1996 revealed that elderly diabetics had twice the risk of developing a foot ulcer, three times the risk of developing a foot abscess and four times the risk of developing Osteomyelitis.…”

Diyabetik ayak: Patogenez, klinik tablolar ve tedavileri, eş zamanlı hastalıklar

“…[16] Diyabetik ayak ülserlerinin %70-90'ı ayağın ön kıs-mında görülür; sıklık sırasına göre topuk ve ayağın ortası bunu izler. [11] En sık kullanılan ülser sınıflandır-maları Wagner [17] , Brodsky [18] , University of Texas [19] , PEDIS [20] ve SINBAD [21] sınıflandırmalarıdır (Tablo 3). Diyabetik ayak ülserinde prognoza yönelik diyabetik ülser şiddet skoru (diabetic ulcer severity score -DUSS) tarif edilmiştir (Tablo 3).…”

“…SINBAD (Site-Ischemia-Neuropathy-Bacterial infection-Area-Depth) sınıflandırması [21] Ülserin CNO'nun klinik evrelemesi Eichenholtz tarafından yapılmıştır. [30] Evre 1 akut inflamatuvar dönemdir, radyografide kemiklerde parçalanma, eklemlerde çıkık görülür.…”