Classification of foot ulcers in people with diabetes: A systematic review.

Autor: Monteiro-Soares M; Portuguese Red Cross School of Health - Lisbon, Lisbon, Portugal.; MEDCIDS - Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine of the University of Porto, Porto, Portugal.; RISE@CINTESIS, Faculty of Medicine Oporto University, Porto, Portugal., Hamilton EJ; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.; University of Western Australia, Medical School, Fiona Stanley Hospital, Murdoch, Western Australia, Australia., Russell DA; Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.; Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK., Srisawasdi G; Department of Rehabilitation Medicine, Sirindhorn School of Prosthetics Orthotics, Bangkok, Thailand.; Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand., Boyko EJ; Department of Medicine, University of Washington, Seattle, Washington, USA.; Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA., Mills JL; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA., Jeffcoate W; Nottingham University Hospitals NHS Trust, Nottingham, UK., Game F; University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
Jazyk: angličtina
Zdroj: Diabetes/metabolism research and reviews [Diabetes Metab Res Rev] 2024 Mar; Vol. 40 (3), pp. e3645. Date of Electronic Publication: 2023 May 02.
DOI: 10.1002/dmrr.3645
Abstrakt: Background: Classification and scoring systems can help both clinical management and audit the outcomes of routine care.
Aim: This study aimed to assess published systems used to characterise ulcers in people with diabetes to determine which should be recommended to (a) aid communication between health professionals, (b) predict clinical outcome of individual ulcers, (c) characterise people with infection and/or peripheral arterial disease, and (d) audit to compare outcomes in different populations. This systematic review is part of the process of developing the 2023 guidelines to classify foot ulcers from the International Working Group on Diabetic Foot.
Methods: We searched PubMed, Scopus and Web of Science for articles published up to December 2021 which evaluated the association, accuracy or reliability of systems used to classify ulcers in people with diabetes. Published classifications had to have been validated in populations of >80% of people with diabetes and a foot ulcer.
Results: We found 28 systems addressed in 149 studies. Overall, the certainty of the evidence for each classification was low or very low, with 19 (68%) of the classifications being assessed by ≤ 3 studies. The most frequently validated system was the one from Meggitt-Wagner, but the articles validating this system focused mainly on the association between the different grades and amputation. Clinical outcomes were not standardized but included ulcer-free survival, ulcer healing, hospitalisation, limb amputation, mortality, and cost.
Conclusion: Despite the limitations, this systematic review provided sufficient evidence to support recommendations on the use of six particular systems in specific clinical scenarios.
(© 2023 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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