Color-coded etiological keys: A simple survey tool towards amputation-free limb survival in diabetic foot lesions

We devised a simple implementable color-coded etiological key survey based on six significant categories to screen and manage all diabetic foot patients. The study results were analyzed to verify the impact of this survey.

First we carried out a retrospective internal survey of all diabetic patients that presented to us during the period from January 2004 to January 2007. We used this analysis to develop the color-coded etiological survey, and applied it to analyze patients prospectively for 5 years from May 2007 to May 2012. Out of 4,102 diabetic foot patients, 739 patients were referred by other medical facilities for major amputation as a result of the severity of their foot lesions. This group was then subjected to further analysis to study the value and impact of the survey on amputation-free limb survival.

Blood quality abnormalities were most prevalent followed by peripheral occlusive diseases, whereas tissue loss was the least. After the completion of the assessment process, management was implemented according to the defined protocol based on the lesions' characteristics. The primary end-point of major amputation-free limb survival was achieved in 72.5% of patients, with an average hospital stay of 13.3 days. Statistical analysis of the etiological keys showed a significant impact of tissue loss, and previous foot surgery as a poor predictor of limb loss.

We conclude that the implementation of the color-coded etiological key survey can provide efficient and effective service to diabetic foot victims with comparable outcomes to dedicated diabetic foot clinics.