Document Detail

Comparison of three systems of classification in predicting the outcome of diabetic foot ulcers in a Brazilian population.
MedLine Citation:
PMID:  18603574     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The 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. METHODS: Ulcer 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. RESULTS: Mean 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 <or=9 (total possible 15) were 7.6 times more likely to heal than scores >or=10 (P<0.001). CONCLUSIONS: All 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.
Maria Cândida R Parisi; Denise E Zantut-Wittmann; Elizabeth J Pavin; Helymar Machado; Márcia Nery; William J Jeffcoate
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-07-04
Journal Detail:
Title:  European journal of endocrinology / European Federation of Endocrine Societies     Volume:  159     ISSN:  1479-683X     ISO Abbreviation:  Eur. J. Endocrinol.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-22     Completed Date:  2008-10-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423848     Medline TA:  Eur J Endocrinol     Country:  England    
Other Details:
Languages:  eng     Pagination:  417-22     Citation Subset:  IM    
Endocrinology Division, Internal Medicine Department, Medical School, State University of Campinas, Campinas, SP, Brazil.
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MeSH Terms
Aged, 80 and over
Diabetic Foot / classification*,  pathology*,  surgery
Diabetic Neuropathies / diagnosis
Infection / diagnosis
Ischemia / diagnosis
Logistic Models
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Prospective Studies
Sepsis / diagnosis
Severity of Illness Index*
Wound Healing*

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