Comparison of two classification systems in predicting the outcome of diabetic foot ulcers: the Wagner grade and the Saint Elian Wound score systems

Background: Many wound assessment systems including the Wagner classification and University of Texas (UT) grading system have been previously described. The authors of this study applied the DIRECT (Debridement of necrosis, Infection control, Revascularization, Exudate control, Chronicity, and Top surface) wound coding system for initial assessment of diabetic foot ulcers (DFUs) to predict limb salvage and prognosis.<br/>Methods: From January 2016 to February 2020, a total of 169 first-time DFU patients were retrospectively evaluated using the DIRECT wound coding assessment system. DFUs were followed up for at least 6 months, and scores in each component of the coding system according to final limb status were statistically evaluated. The coding assessment’s ability to predict major amputation was compared to those of the Wagner classification and the UT grading system.<br/>Results: Subjects were divided into complete healing (n=80, 47.3%), not healed (n=71, 42%), and amputation (n=18, 10.7%) groups. The mean values of each component of DIRECT assessment for the complete healing/amputation groups were D 0.86/1.56 (P<0.001), I 0.46/0.89 (P=0.001), R 0.65/0.94 (P=0.014), E 1.15/1.56 (P=0.049), C 0.69/0.89 (P=0.086), T 0.53/0.72 (P=0.13) and the sum was 3.140/4.741 (P<0.001). The area under the receiver operating characteristic curve of the DIRECT, Wagner, and UT grading systems was 0.722, 0.603, and 0.663, respectively.<br/>Conclusion: The DIRECT coding system shows a greater association with prediction of amputation or complete healing, compared with the Wagner and UT wound classification systems. This more accurate wound assessment system will be helpful in predicting prognosis and planning treatments.

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Comparison of three systems of classification in predicting the outcome of diabetic foot ulcers in a Brazilian population

Acta Endocrinologica ◽

10.1530/eje-07-0841 ◽

2008 ◽

Vol 159 (4) ◽

pp. 417-422 ◽

Cited By ~ 21

Author(s):

Maria Cândida R Parisi ◽

Denise E Zantut-Wittmann ◽

Elizabeth J Pavin ◽

Helymar Machado ◽

Márcia Nery ◽

...

Keyword(s):

Diabetic Foot ◽

Strong Association ◽

Primary Outcome Measure ◽

Classification Systems ◽

Foot Ulcers ◽

Consecutive Series ◽

Diabetic Foot Ulcers ◽

University Of Texas ◽

The University

ObjectiveThe aim was to compare three ulcer classification systems as predictors of the outcome of diabetic foot ulcers: the Wagner, the University of Texas (UT) and the size (area, depth), sepsis, arteriopathy, denervation system (S(AD)SAD) systems in a specialist clinic in Brazil.MethodsUlcer area, depth, appearance, infection and associated ischaemia and neuropathy were recorded in a consecutive series of 94 subjects. A novel score, the S(AD)SAD score, was derived from the sum of individual items of the S(AD)SAD system, and was evaluated. Follow-up was for at least 6 months. The primary outcome measure was the incidence of healing.ResultsMean age was 57.6 years; 57 (60.6%) were male. Forty-eight ulcers (51.1%) healed without surgery; 11 (12.2%) subjects underwent minor amputation. Significant differences in terms of healing were observed for depth (P=0.002), infection (P=0.006) and denervation (P=0.002) using the S(AD)SAD system, for UT grade (P=0.002) and stage (P=0.032) and for Wagner grades (P=0.002). Ulcers with an S(AD)SAD score of ≤9 (total possible 15) were 7.6 times more likely to heal than scores ≥10 (P<0.001).ConclusionsAll three systems predicted ulcer outcome. The S(AD)SAD score of ulcer severity could represent a useful addition to routine clinical practice. The association between outcome and ulcer depth confirms earlier reports. The association with infection was stronger than that reported from the centres in Europe or North America. The very strong association with neuropathy has only previously been observed in Tanzania. Studies designed to compare the outcome in different countries should adopt systems of classification, which are valid for the populations studied.

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Diabetic foot ulcers: a review of current management

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20174916 ◽

2017 ◽

Vol 5 (11) ◽

pp. 4683 ◽

Cited By ~ 2

Author(s):

Yasmee Khan ◽

Manal M. Khan ◽

M. Raza Farooqui

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Health Condition ◽

Classification Systems ◽

Present Review ◽

Socioeconomic Impact ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Current Management ◽

Patient Morbidity

Diabetic foot ulcers are a serious complication of diabetes mellitus which increases the patient morbidity and also have significant socioeconomic impact. The present review aims to summarize the causes and pathogenesis leading to diabetic foot ulcers, various classification systems and to focus on the current management of this significant and preventable health condition.

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Principles of STAGE Management for Diabetic Foot Ulcers Based on the Wagner and Texas Classification Systems

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734619863914 ◽

2019 ◽

Vol 18 (4) ◽

pp. 367-375

Author(s):

Chaojun Zhu ◽

Bing Zhou ◽

Jiakang Lü ◽

Ping Yue ◽

Xianzhou Liu ◽

...

Keyword(s):

Diabetic Foot ◽

Classification Systems ◽

Wound Management ◽

Foot Ulcers ◽

Layer By Layer ◽

Wound Treatment ◽

Diabetic Foot Ulcers ◽

Similar Treatment ◽

Treatment Principles ◽

Infected Area

The current Wagner and Texas classifications of diabetic foot ulcers (DFUs) are used worldwide to assess the extent of foot lesions, but wound treatment principles based on both the classification systems are lacking. We have summarized the STAGE principles of wound treatment for clinical practice based on the Wagner and Texas classification systems. The STAGE principles refer to the principles of surgical intervention during wound treatment of DFUs and emphasize that “based on anatomical layers, the management focuses on blood supply and includes layer-by-layer incision to the infected area, maintenance of effective wound drainage, and step-by-step treatment of the wound.” During treatment, microcirculation improvement and microvascular angiogenesis (A) are essential for granulation tissue formation in the bone (skeleton, S) and tendons (T) and healing of the wound with reepithelialization (E). We defined the above mentioned steps as the STAGE principles, namely, layer-by-layer incision and step-by-step management (Phase A is essential for the treatments in Phases S-T and G-E). Ulcers or gangrene formed during Phases S-T or T should be treated according to the STAGE or TAGE principles, respectively. Similar treatment principles are applied in the other phases. However, treatments at each phase are not isolated and can be performed simultaneously. The STAGE principle can be combined with the tissue, infection, moisture, and wound edge (TIME) and TIME-H chronic wound treatment principles to eliminate the shortcomings of a single principle in wound management.

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PEDIS Classification in Diabetic Foot Ulcers Patients

Journal of Indonesian Society for Vascular and Endovascular Surgery ◽

10.36864/jinasvs.2020.2.012 ◽

2020 ◽

Vol 1 (2) ◽

pp. 50-54

Author(s):

Radi Noorsyawal ◽

Fahmi Jaka Yusuf ◽

Kemas Dahlan ◽

Ratna Maila Dewi

Keyword(s):

Peripheral Arterial Disease ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Arterial Disease ◽

The United States ◽

Classification Systems ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Peripheral Arterial

Introduction: Diabetic foot ulcer are one of several serious complications of diabetes progression. Up to 15% of patients with diabetes have diabetic foot ulcer and these ulcers lead to more than 80,000 amputations per year in the United States. Many DFU classification systems have been proposed to predict clinical outcome; however, almost of these systems have limitations. To categorize and define DFU objectively, the International Working Group of the Diabetic Foot (IWGDF) developed the PEDIS classification system. These collective findings and because of there is no findings of characteristic of DFU based on PEDIS classification in Mohammad Hoesin Hospital indicate that this research is needed to do. Method: This is a prospective study at Mohammad Hoesin hospital, Palembang. The aim is to describe the characteristic of diabetic foot ulcers based on PEDIS classification. There were 41 cases evaluated under this study. Results: Peripheral arterial disease is the most problem in perfusion. 1-3 cm2 is the most happen in extent. Wound depth on fascia or muscle or tendon is the most happen. Abscess or fascitis is the most problem in infection. Loss of sensation is the most happen. PEDIS score ≥ 7 is the most happen. Conclusion: Early prevention and treatment from vascular and endovascular surgery can be considered as the most important for the management of diabetic foot ulcers patient. Keywords: Diabetic Foot Ulcer, PEDIS classification, Peripheral Arterial Disease

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