Study of Efficacy of Scoring System in Predicting the Clinical Outcome of Diabetic Foot Ulcers
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N\AAbstract
The burden of DFUs is immense, not only because of the physical toll it takes on patients, but also due to the associated economic costs, which often involve extended hospital stays, surgeries, and rehabilitation Therefore, early detection and effective management of DFUs are crucial to reducing the risk of amputation and improving patient outcomes. However, the challenge lies in identifying the diabetic patients whose foot ulcers are at risk of progressing to amputation and those who can be successfully treated with non-invasive interventions
This study aims to assess the efficacy of two relatively newer scoring systems—DUSS (Diabetic Ulcer Severity Score) and SINBAD (Site, Ischemia, Neuropathy, Bacterial infection, Area Depth)—in predicting the clinical outcomes of diabetic foot ulcers. These scoring systems are more comprehensive and take into account a wider range of variables that may influence ulcer healing or the need for amputation. Furthermore, this study compares the efficacy of DUSS and SINBAD with that of Wagner’s Classification and the University of Texas Classification, in order to determine which system provides the most accurate predictions of clinical outcomes.
Objective: To assess the efficacy of various foot scoring system for diabetic foot ulcers in predicting the clinical outcome and for prediction of their clinical outcomes
Materials And Methods: All patients ( both in and out patients ) , admitted or referred from medical or from any other departments to the SICU and General Surgery Department and its allied sub specialties were included in the study .
Results And Observation: In our study Sinbad score the healing probability in score 1 was 100%, score 2 score 2 was 92.11% Score 3 was 72.34%, score 4 was 58.6% healing, score 5 was9.09% and score 6 was 0% healing. In our study according to the Kaplan Meier analysis the probability of healing with duss score -0 was 100%, 84% probability of healing for score 1 while that of score 2 had 19% probability of healing. Patient with DUSS 3 and 4 had 0% probability of healing, DUSS score had a Sensitivity of 98.50% and a specificity of 100.00% to predict amputation . SINDABD score had a Sensitivity of 100.00%and a specificity of 100.00%. DUSS score had a Sensitivity of 98.50% and a specificity of 100.00% to predict amputation . SINDABD score had a Sensitivity of 100.00%and a specificity of 100.00%.
Conclusion: The ultimate goal of all the existing classification systems that toward grading the severity of the ulcer. These systems work as a tool for risk stratification and assessment and selection of the proper treatment course, which are crucial in achieving better patient outcomes
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References
Mellitus D. Diagnosis and classification of diabetes mellitus. Diabetes care. 2005 Jan 1;28(S37):S5-10.
Alam U, Asghar O, Azmi S, Malik RA. General aspects of diabetes mellitus. Handbook of clinical neurology. 2014 Jan 1;126:211-222.
Lakhtakia R. The history of diabetes mellitus. Sultan Qaboos University Medical Journal. 2013 Aug;13(3):368.
Tripathi BK, Srivastava AK. Diabetes mellitus: complications and therapeutics. Medical science monitor. 2006 Jul 1;12(7):RA130-147.
Nathan DM. Long-term complications of diabetes mellitus. New England journal of medicine. 1993 Jun 10;328(23):1676-1685.
Lotfy M, Adeghate J, Kalasz H, Singh J, Adeghate E. Chronic complications of diabetes mellitus: a mini review. Current diabetes reviews. 2017 Feb 1;13(1):3-10. Syafril S. Pathophysiology diabetic foot ulcer. InIOP Conference Series: Earth and Environmental Science . IOP Publishing. 2018 Mar 1;125(1):012161.
Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I. Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study. Journal of foot and ankle research. 2019 Dec;12(1):1-8.
Hicks CW, Canner JK, Mathioudakis N, Lippincott C, Sherman RL, Abularrage CJ. Incidence and risk factors associated with ulcer recurrence among patients with diabetic foot ulcers treated in a multidisciplinary setting. Journal of Surgical Research. 2020 Feb 1;246:243-250.
Davis FM, Kimball A, Boniakowski A, Gallagher K. Dysfunctional wound healing in diabetic foot ulcers: new crossroads. Current diabetes reports. 2018 Jan;18(1):1-8.
Xu F, Zhang C, Graves DT. Abnormal cell responses and role of TNF-in impaired diabetic wound healing. BioMed research international. 2013;2013.
Pradhan L, Nabzdyk C, Andersen ND, LoGerfo FW, Veves A. Inflammation and neuropeptides: the connection in diabetic wound healing. Expert reviews in molecular medicine. 2009 Jan;11.
Falanga V. Wound healing and its impairment in the diabetic foot. The Lancet. 2005 Nov 12;366(9498):1736-43.
Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in diabetes. The Journal of clinical investigation. 2007 May 1;117(5):1219-22.
Peppa M, Stavroulakis P, Raptis SA. Advanced glycoxidation products and impaired diabetic wound healing. Wound Repair and Regeneration. 2009 Jul;17(4):461-72.
Kumar VH, Moghadam AG. A study to test the validity of diabetic ulcer severity score (DUSS) at tertiary care hospital. International Surgery Journal. 2017 Nov 25;4(12):4010-4014.
Venkataramana AV, Manjunath BD, Razack A, Harindranath HR, Arish H. A prospective study to determine the application of site, ischemia, neuropathy, bacterial infection and depth scoring in the outcome and management of diabetic foot ulcers. International Surgery Journal. 2020 Jan 27;7(2):478-83.
Kumar S, Arava S, Pavan BM, Kiran G, Chandan GB, Kumar N. Diabetic ulcer severity score: clinical validation and outcome. International Surgery Journal. 2016 Dec 9;3(3):1606-10.
Shashikala CK, Nandini VK, Kagwad S. Validation of Diabetic Ulcer Severity Score (DUSS).2017; 3:234-237.
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