Diabetic foot classification: Difference between revisions
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==Classification== | ==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]], outpatient management or [[Hospital|hospitalization]], and [[surgery|surgical intervention]]. 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> | *[[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]], outpatient management or [[Hospital|hospitalization]], and [[surgery|surgical intervention]]. | ||
*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 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> | *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> | ||
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! style="background: #F5F5F5; padding: 0 10px;" | Severe | ! style="background: #F5F5F5; padding: 0 10px;" | Severe | ||
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*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]] | |||
|} | |} | ||
Revision as of 17:00, 6 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]
Overview
Diabetic foot is classified according to its severity and factors such as the requirement of oral or parenteral antibiotics, outpatient management or hospitalization, and surgical intervention.
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 or hospitalization, and surgical intervention.
- 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.[1]
- The International Working Group on the Diabetic Foot (IWGDF) published a similar classification system in 2012.[2]
- 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.[3]
|
- 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.[4]
| 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
- ↑ 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.
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