Page 1 of 24
Accepted Preprint first posted on 4 July 2008 as Manuscript EJE-07-0841
Comparison of three systems of classification in predicting outcome of diabetic foot ulcers in a Brazilian population
Running Title: Diabetic foot ulcers outcome Word count: 3279
Maria Cândida R. Parisia,c, Denise E. Zantut-Wittmanna, Elizabeth J. Pavina, Helymar Machadob, Márcia Nery c, William J. Jeffcoated
a
Endocrinology Division, Internal Medicine Department,
b
Statistical Nucleus of Research Commission, Medical School of the State
University of Campinas, Campinas-SP, Brazil; c
Endocrinology Department, Medical School of the State University of São
Paulo, São Paulo, Brazil d
Foot Ulcer Trials Unit, Department of Diabetes and Endocrinology,
Nottingham University Hospitals Trust, City Hospital Campus, Nottingham, UK
CORRESPONDING AUTHOR: Maria Cândida Ribeiro Parisi Disciplina de Endocrinologia, Departamento de Clínica Médica Faculdade de Ciências Médicas Universidade Estadual de Campinas PO Box 6111 Rua Tessália Vieira de Camargo, 126 – Barão Geraldo 13084-971 – Campinas –SP – Brazil 1
Page 2 of 24
Fax – phone: (55) (19) 3521 7408 E-mail:
[email protected]
Key words: 1- Diabetic foot 2- Foot Care 3- Foot Complications 4 Foot ulcer 5 Classification 6 Outcome
2
Page 3 of 24
Abstract 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 S(AD)SAD system 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. 48 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 a S(AD)SAD score of 9 (total possible 15) were 7.6 times more likely to heal than scores 10 (p
