Classification systems for lower extremity amputation prediction in subjects with active diabetic foot ulcer: a systematic review and meta-analysis

• Type: Article in International Scientific Journal
• Date: 2014

Authors

Matilde Soares (Author) FMUP; Martins Mendes, D (Author) Other; Vaz Carneiro, A (Author) Other; Sampaio, S (Author) Other; Mario Dinis Ribeiro (Author) FMUP

Journal

Title: Diabetes/Metabolism Research and Reviews

Vol. 30

Pages: 610-622

ISSN: 1520-7552

Publisher: Wiley-Blackwell

Indexing

ISI Web of Knowledge - 36 Citations

Scopus - 37 Citations

Other information

Authenticus ID: P-009-XWJ

DOI: 10.1002/dmrr.2535

Abstract (EN): AimWe systematically review the available systems used to classify diabetic foot ulcers in order to synthesize their methodological qualitative issues and accuracy to predict lower extremity amputation, as this may represent a critical point in these patients' care. Material and MethodsTwo investigators searched, in EBSCO, ISI, PubMed and SCOPUS databases, and independently selected studies published until May 2013 and reporting prognostic accuracy and/or reliability of specific systems for patients with diabetic foot ulcer in order to predict lower extremity amputation. ResultsWe included 25 studies reporting a prevalence of lower extremity amputation between 6% and 78%. Eight different diabetic foot ulcer descriptions and seven prognostic stratification classification systems were addressed with a variable (1-9) number of factors included, specially peripheral arterial disease (n=12) or infection at the ulcer site (n=10) or ulcer depth (n=10). The Meggitt-Wagner, S(AD)SAD and Texas University Classification systems were the most extensively validated, whereas ten classifications were derived or validated only once. Reliability was reported in a single study, and accuracy measures were reported in five studies with another eight allowing their calculation. Pooled accuracy ranged from 0.65 (for gangrene) to 0.74 (for infection). ConclusionThere are numerous classification systems for diabetic foot ulcer outcome prediction, but only few studies evaluated their reliability or external validity. Studies rarely validated several systems simultaneously and only a few reported accuracy measures. Further studies assessing reliability and accuracy of the available systems and their composing variables are needed. Copyright (c) 2014 John Wiley & Sons, Ltd.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 13