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Diabetic foot ulcer classifications: A critical review
Matilde Monteiro-Soares1,2, Edward J Boyko3, William Jeffcoate4
1Departamento de Medicina da Comunidade, Informação e Decisão em Saúde (MEDCIDS), Faculdade de Medicina da Universidade do Porto, Oporto, Portugal.
Diabetes/Metabolism Research and Reviews
|March 17, 2020
Summary
This study evaluated diabetic foot ulcer (DFU) classification systems, recommending specific ones for clinical use based on validity and purpose. The research identified key factors for healing and assessed 19 systems for their clinical applicability.
Area of Science:
- Diabetology
- Wound Care
- Clinical Epidemiology
Background:
- Diabetic foot ulcers (DFUs) present a significant clinical challenge.
- Standardized classification and scoring systems are crucial for managing DFU care and auditing outcomes.
- Existing systems vary widely, necessitating an evaluation for clinical utility.
Purpose of the Study:
- To assess published diabetic foot ulcer classification systems.
- To determine which systems are most appropriate for specific clinical purposes.
- To provide recommendations for the use of DFU classifications in clinical practice.
Main Methods:
- Systematic review of published DFU classification systems.
- Inclusion criteria: validation in populations >75% people with diabetes and a foot ulcer.
- Assessment of internal/external validity, reliability, and inclusion of 8 key factors for healing failure.
Main Results:
- Nineteen DFU classification systems met inclusion criteria from 37 identified.
- Systems varied in purpose, population, validation, and reliability.
- Only 6 systems were developed in multicenter studies; 13 were externally validated.
Conclusions:
- Despite limitations, evidence supports recommendations for specific DFU classification systems.
- Classifications can aid communication, predict outcomes, guide management, and facilitate audits.
- Further standardization and validation of DFU classification tools are warranted.
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