Diabetic foot classification: Difference between revisions
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! align="center" style="background: #DCDCDC; padding: 0 10px;" | '''IDSA Severity''' | ! align="center" style="background: #DCDCDC; padding: 0 10px;" | '''IDSA Severity''' | ||
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| style="background: #F5F5F5; padding: 0 10px;" | '''No symptoms or signs of infection''' | | 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;" | 1 | ||
! style="background: #F5F5F5; padding: 0 10px;" | Uninfected | ! 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> signs of SIRS | | 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. | * If [[erythema]], must be >0.5 cm to ≤2 cm around the [[ulcer]]. | ||
* Exclude other causes of an inflammatory response of the skin (eg, trauma, gout, acute | * 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;" | 2 | ||
! style="background: #F5F5F5; padding: 0 10px;" | Mild | ! 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> signs of SIRS | | 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;" | 3 | ||
! style="background: #F5F5F5; padding: 0 10px;" | Moderate | ! style="background: #F5F5F5; padding: 0 10px;" | Moderate | ||
|- | |- | ||
| style="background: #F5F5F5; padding: 0 10px;" | '''Local infection with the signs of SIRS''', as manifested by ≥2 of the following: | | 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 | * Temperature >38 °C or <36 °C | ||
* Heart rate >90 beats/min | * [[Heart rate]] >90 beats/min | ||
* Respiratory rate >20 breaths/min or PaCO2 <32 mm Hg | * [[Respiratory rate]] >20 breaths/min or PaCO2 <32 mm Hg | ||
* White blood cell count >12,000 or <4,000 cells/μL or ≥10% immature (band) forms | * [[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;" | 4 | ||
! style="background: #F5F5F5; padding: 0 10px;" | Severe | ! style="background: #F5F5F5; padding: 0 10px;" | Severe |
Revision as of 21:25, 28 January 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 it's severity and factors such as 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 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]
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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.