Am Fam Physician. 2004 Sep 1;70(5):955.
Approximately 15 percent of patients with diabetes develop a foot ulcer. One half of these ulcers are secondary to diabetic neuropathy, which is defined as a lack of protective sensation and adequate arterial blood flow to the foot. Treatment options for these foot ulcers includes debridement of necrotic tissue, removing the pressure on the area of the ulcer, and use of moist dressings. There currently are no models that predict which foot ulcers will heal with standard therapy. Margolis and colleagues developed a clinical prediction model that can determine which diabetic neuropathic foot ulcers will respond to standard therapy in a reasonable amount of time.
The cohort study centered on patients with diabetic neuropathic foot ulcers. Researchers used a database from the administrative and medical records of a large wound care system. The clinicians involved in the care of these patients used a standard algorithm of wound care that included debridement and reducing stress on the wound. The main outcome measurement was wound healing by week 20 of care. The patient’s age and sex, the duration of the oldest wound, the size of the largest wound, the grade of the most severe wound, and the number of wounds were evaluated as prognostic factors. The authors evaluated several prognostic models of varying complexity.
There were 27,630 patients enrolled in the study. Of these, 12,983 (47 percent) achieved healing of a diabetic neuropathic foot ulcer by week 20 of care. The prognostic model that was the simplest counted one point each for a wound older than two months or larger than 2 cm2, or a grade of at least three on a six-point wound assessment scale. The likelihood of a wound healing in a reasonable time was less in patients whose score was zero compared with patients whose score was three. A wound that had a score of two or more was not healed by week 20 of care in 79 percent of cases. There was some minor loss of accuracy using this model when compared with the more complex models.
The authors conclude that this simple model, using prognostic factors that are already part of the wound care examination, can be used to determine which diabetic neuropathic foot ulcers are likely to heal. This model can be used to determine which patients are more likely to respond to standard wound care and which patients may need different wound care strategies.
Margolis DJ, et al. Diabetic neuropathic foot ulcers: predicting which ones will not heal. Am J Med. December 1, 2003;115:627–31.
Copyright © 2004 by the American Academy of Family Physicians.
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