Diabetic foot classification: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Diabetic foot}} | {{Diabetic foot}} | ||
{{CMG}} {{AE}} {{DG}} {{Anahita}} | |||
==Overview== | |||
[[Diabetic foot]] is classified based on [[ulcer]]'s features in order to assist with clinical decision-making regarding the need for [[mouth|oral]] or [[Route of administration|parenteral]] [[antibiotics]], [[patient|outpatient]] management, [[Hospital|hospitalization]], and [[surgery|surgical intervention]]. There are multiple methods of classification for [[diabetic foot]]. One of them that has been published by The Infectious Disease Society of America (IDSA) in their 2004 guideline and mainly has been focused on the extent of [[infection]] and [[inflammation]] of the [[ulcer]]. In addition another similar classification system has been released by The International Working Group on the [[Diabetic Foot]] (IWGDF) in 2012. The aforementioned systems were externally validated in a longitudinal study to assess [[Prognosis|prognostic value]], which demonstrated increased risk for [[amputation]] among [[patients]] with [[infections]] classified as severe. Another widely accepted [[diabetic foot]] [[ulcer]] classification is Wagner [[ulcer]] classification system, which uses some [[ulcer]]'s features such as depth, in addition to presence of [[osteomyelitis]] or [[gangrene]]. | |||
==Classification== | |||
*[[Diabetic foot]] [[infections]] are classified according to the severity of involvement to assist with clinical decision-making regarding the need for [[mouth|oral]] or [[Route of administration|parenteral]] [[antibiotics]], [[patient|outpatient]] management, need for [[Hospital|hospitalization]], and [[surgery|surgical intervention]].<ref name="Dinker R Pai2013">{{cite journal|last1=Dinker R Pai|first1=Simerjit Singh|title=Diabetic Foot Ulcer – Diagnosis and Management|journal=Clinical Research on Foot & Ankle|volume=01|issue=03|year=2013|issn=2329910X|doi=10.4172/2329-910X.1000120}}</ref> | |||
*The Infectious Disease Society of America (IDSA) introduced a classification scheme for these [[infections]] in their 2004 guidelines, broadly categorized as mild, moderate, and severe [[infections]] based upon the extent of [[infection]] and [[inflammation]].<ref name="pmid22619242">{{cite journal| author=Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG et al.| title=2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. | journal=Clin Infect Dis | year= 2012 | volume= 54 | issue= 12 | pages= e132-73 | pmid=22619242 | doi=10.1093/cid/cis346 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22619242}} </ref> | |||
*The International Working Group on the [[Diabetic Foot]] (IWGDF) published a similar classification system in 2012.<ref name="pmid22271739">{{cite journal|author=Lipsky BA, Peters EJ, Senneville E, Berendt AR, Embil JM, Lavery LA, Urbancic-Rovan V, Jeffcoate WJ|title=Expert opinion on the management of infections in the diabetic foot.|journal=Diabetes Metab Res Rev|year=2012|volume=28|issue=1|pages=163-78|pmid=22271739|doi=|url=http://www.ncbi.nlm.nih.gov/pubmed/22271739}}</ref> | |||
*The aforementioned systems were externally validated in a longitudinal study to assess [[Prognosis|prognostic value]], which demonstrated increased risk for [[amputation]] among [[patients]] with [[infections]] classified as severe.<ref name="pmid17243061">{{cite journal|author=Lavery LA, Armstrong DG, Murdoch DP, Peters EJ, Lipsky BA|title=Validation of the Infectious Diseases Society of America's diabetic foot infection classification system.|journal=Clin Infect Dis|year=2007|volume=44|issue=4|pages=562-5|pmid=17243061|doi=|url=http://www.ncbi.nlm.nih.gov/pubmed/17243061}}</ref> | |||
{| | |||
| style="width: 15px;"| | |||
| | |||
{| style="border: 2px solid #DCDCDC; font-size: 90%;" | |||
! align="center" style="background: #DCDCDC;" | '''Clinical Manifestation''' | |||
! align="center" style="background: #DCDCDC; padding: 0 10px;" | '''PEDIS Grade''' | |||
! align="center" style="background: #DCDCDC; padding: 0 10px;" | '''IDSA Severity''' | |||
|- | |||
| style="background: #F5F5F5; padding: 0 10px;" | '''No [[symptoms]] or [[Medical sign|signs]] of [[infection]]''' | |||
! style="background: #F5F5F5; padding: 0 10px;" | 1 | |||
! style="background: #F5F5F5; padding: 0 10px;" | Uninfected | |||
|- | |||
| style="background: #F5F5F5; padding: 0 10px;" | '''Local [[infection]] involving only the [[skin]] and the [[subcutaneous tissue]]''' <u>without</u> involvement of deeper tissues and <u>without</u> [[Medical sign|signs]] of [[Systemic inflammatory response syndrome|SIRS]] | |||
* If [[erythema]], must be >0.5 cm to ≤2 cm around the [[ulcer]]. | |||
* Exclude other causes of an [[inflammation|inflammatory response]] of the [[skin]] (eg, [[Physical trauma|trauma]], [[gout]], [[Charcot joint|acute charcot neuro-osteoarthropathy]], [[Bone fracture|fracture]], [[thrombosis]], [[venous stasis]]). | |||
! style="background: #F5F5F5; padding: 0 10px;" | 2 | |||
! style="background: #F5F5F5; padding: 0 10px;" | Mild | |||
|- | |||
| style="background: #F5F5F5; padding: 0 10px;" | '''Local [[infection]] with [[erythema]] >2 cm or involving structures deeper than [[skin]] and [[subcutaneous tissues]]''' (eg, [[abscess]], [[osteomyelitis]], [[septic arthritis]], [[fasciitis]]) <u>without</u> [[Medical sign|signs]] of [[Systemic inflammatory response syndrome|SIRS]] | |||
! style="background: #F5F5F5; padding: 0 10px;" | 3 | |||
! style="background: #F5F5F5; padding: 0 10px;" | Moderate | |||
|- | |||
| style="background: #F5F5F5; padding: 0 10px;" | '''Local [[infection]] with the [[Medical sign|signs]] of [[Systemic inflammatory response syndrome|SIRS]]''', as manifested by ≥2 of the following: | |||
* Temperature >38 °C or <36 °C | |||
* [[Heart rate]] >90 beats/min | |||
* [[Respiratory rate]] >20 breaths/min or PaCO2 <32 mm Hg | |||
* [[Neutrophil|White blood cell count]] >12,000 or <4,000 cells/μL or ≥10% [[Bandemia|immature (band) forms]] | |||
! style="background: #F5F5F5; padding: 0 10px;" | 4 | |||
! style="background: #F5F5F5; padding: 0 10px;" | Severe | |||
|} | |||
|} | |||
<br> | |||
*Another widely accepted [[diabetic foot]] [[ulcer]] classification is Wagner [[ulcer]] classification system, which uses some [[ulcer]]'s features such as depth, in addition to presence of [[osteomyelitis]] or [[gangrene]].<ref name="Wagner1987">{{cite journal|last1=Wagner|first1=F William|title=The Diabetic Foot|journal=Orthopedics|volume=10|issue=1|year=1987|pages=163–172|issn=0147-7447|doi=10.3928/0147-7447-19870101-28}}</ref> | |||
**Unfortunately Wagner [[ulcer]] classification system does not address important factors such as [[ischemia]] and [[infection]]. | |||
**The following table is a summary of Wagner [[ulcer]] classification system: | |||
{| border="3" | |||
! Grade !! [[Ulcer]]'s Features | |||
|- | |||
| 0 || Not an obvious open lesion | |||
|- | |||
| 1 || Superficial [[ulcer]] with partial or full-thickness | |||
|- | |||
| 2 || Extension of [[ulcer]] to other structures such as [[tendon]], [[ligament]], [[joint|joint capsule]], or [[fascia|deep fascia]] (without [[abscesses]] or [[osteomyelitis]]) | |||
|- | |||
| 3 || Extension of [[ulcer]] to other structures such as [[tendon]], [[ligament]], [[joint|joint capsule]], or [[fascia|deep fascia]] with [[abscesses]], [[osteomyelitis]] or [[septic arthritis]] | |||
|- | |||
| 4 || Presence of [[gangrene]], but localized to [[foot|forefoot]] or [[foot|heel]] | |||
|- | |||
| 5 || Presence of extensive [[gangrene]] | |||
|} | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
Latest revision as of 19:49, 29 July 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Daniel A. Gerber, M.D. [2] Anahita Deylamsalehi, M.D.[3]
Overview
Diabetic foot is classified based on ulcer's features in order to assist with clinical decision-making regarding the need for oral or parenteral antibiotics, outpatient management, hospitalization, and surgical intervention. There are multiple methods of classification for diabetic foot. One of them that has been published by The Infectious Disease Society of America (IDSA) in their 2004 guideline and mainly has been focused on the extent of infection and inflammation of the ulcer. In addition another similar classification system has been released by The International Working Group on the Diabetic Foot (IWGDF) in 2012. The aforementioned systems were externally validated in a longitudinal study to assess prognostic value, which demonstrated increased risk for amputation among patients with infections classified as severe. Another widely accepted diabetic foot ulcer classification is Wagner ulcer classification system, which uses some ulcer's features such as depth, in addition to presence of osteomyelitis or gangrene.
Classification
- Diabetic foot infections are classified according to the severity of involvement to assist with clinical decision-making regarding the need for oral or parenteral antibiotics, outpatient management, need for hospitalization, and surgical intervention.[1]
- The Infectious Disease Society of America (IDSA) introduced a classification scheme for these infections in their 2004 guidelines, broadly categorized as mild, moderate, and severe infections based upon the extent of infection and inflammation.[2]
- The International Working Group on the Diabetic Foot (IWGDF) published a similar classification system in 2012.[3]
- The aforementioned systems were externally validated in a longitudinal study to assess prognostic value, which demonstrated increased risk for amputation among patients with infections classified as severe.[4]
|
- Another widely accepted diabetic foot ulcer classification is Wagner ulcer classification system, which uses some ulcer's features such as depth, in addition to presence of osteomyelitis or gangrene.[5]
| Grade | Ulcer's Features |
|---|---|
| 0 | Not an obvious open lesion |
| 1 | Superficial ulcer with partial or full-thickness |
| 2 | Extension of ulcer to other structures such as tendon, ligament, joint capsule, or deep fascia (without abscesses or osteomyelitis) |
| 3 | Extension of ulcer to other structures such as tendon, ligament, joint capsule, or deep fascia with abscesses, osteomyelitis or septic arthritis |
| 4 | Presence of gangrene, but localized to forefoot or heel |
| 5 | Presence of extensive gangrene |
References
- ↑ Dinker R Pai, Simerjit Singh (2013). "Diabetic Foot Ulcer – Diagnosis and Management". Clinical Research on Foot & Ankle. 01 (03). doi:10.4172/2329-910X.1000120. ISSN 2329-910X.
- ↑ Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG; et al. (2012). "2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections". Clin Infect Dis. 54 (12): e132–73. doi:10.1093/cid/cis346. PMID 22619242.
- ↑ Lipsky BA, Peters EJ, Senneville E, Berendt AR, Embil JM, Lavery LA, Urbancic-Rovan V, Jeffcoate WJ (2012). "Expert opinion on the management of infections in the diabetic foot". Diabetes Metab Res Rev. 28 (1): 163–78. PMID 22271739.
- ↑ Lavery LA, Armstrong DG, Murdoch DP, Peters EJ, Lipsky BA (2007). "Validation of the Infectious Diseases Society of America's diabetic foot infection classification system". Clin Infect Dis. 44 (4): 562–5. PMID 17243061.
- ↑ Wagner, F William (1987). "The Diabetic Foot". Orthopedics. 10 (1): 163–172. doi:10.3928/0147-7447-19870101-28. ISSN 0147-7447.