Classification of foot ulcers in people with diabetes: A systematic review
Issued Date
2023-01-01
Resource Type
ISSN
15207552
eISSN
15207560
Scopus ID
2-s2.0-85158011437
Journal Title
Diabetes/Metabolism Research and Reviews
Rights Holder(s)
SCOPUS
Bibliographic Citation
Diabetes/Metabolism Research and Reviews (2023)
Suggested Citation
Monteiro-Soares M., Hamilton E.J., Russell D.A., Srisawasdi G., Boyko E.J., Mills J.L., Jeffcoate W., Game F. Classification of foot ulcers in people with diabetes: A systematic review. Diabetes/Metabolism Research and Reviews (2023). doi:10.1002/dmrr.3645 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/82313
Title
Classification of foot ulcers in people with diabetes: A systematic review
Author's Affiliation
Siriraj Hospital
UWA Medical School
University Hospitals of Derby and Burton NHS Foundation Trust
Fiona Stanley Hospital
VA Puget Sound Health Care System
University of Washington School of Medicine
Nottingham University Hospitals NHS Trust
University of Leeds, School of Medicine
Faculdade de Medicina da Universidade do Porto (FMUP)
Leeds Teaching Hospitals NHS Trust
Faculty of Medicine Siriraj Hospital, Mahidol University
Universidade do Porto
Baylor College of Medicine
Portuguese Red Cross Health School
UWA Medical School
University Hospitals of Derby and Burton NHS Foundation Trust
Fiona Stanley Hospital
VA Puget Sound Health Care System
University of Washington School of Medicine
Nottingham University Hospitals NHS Trust
University of Leeds, School of Medicine
Faculdade de Medicina da Universidade do Porto (FMUP)
Leeds Teaching Hospitals NHS Trust
Faculty of Medicine Siriraj Hospital, Mahidol University
Universidade do Porto
Baylor College of Medicine
Portuguese Red Cross Health School
Other Contributor(s)
Abstract
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.