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Classification of foot ulcers in people with diabetes: A systematic review.

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Title: Classification of foot ulcers in people with diabetes: A systematic review.
Authors: Monteiro‐Soares, Matilde, Hamilton, Emma J., Russell, David A., Srisawasdi, Gulapar, Boyko, Edward J., Mills, Joseph L., Jeffcoate, William, Game, Fran
Source: Diabetes/Metabolism Research & Reviews; Mar2024, Vol. 40 Issue 3, p1-32, 32p
Subject Terms: PEOPLE with diabetes, MEDICAL personnel, PRESSURE ulcers, PERIPHERAL vascular diseases, DIABETIC foot, MEDICAL communication
Abstract: Background: Classification and scoring systems can help both clinical management and audit the outcomes of routine care. Aim: This study aimed to assess published systems used to characterise ulcers in people with diabetes to determine which should be recommended to (a) aid communication between health professionals, (b) predict clinical outcome of individual ulcers, (c) characterise people with infection and/or peripheral arterial disease, and (d) audit to compare outcomes in different populations. This systematic review is part of the process of developing the 2023 guidelines to classify foot ulcers from the International Working Group on Diabetic Foot. Methods: We searched PubMed, Scopus and Web of Science for articles published up to December 2021 which evaluated the association, accuracy or reliability of systems used to classify ulcers in people with diabetes. Published classifications had to have been validated in populations of >80% of people with diabetes and a foot ulcer. Results: We found 28 systems addressed in 149 studies. Overall, the certainty of the evidence for each classification was low or very low, with 19 (68%) of the classifications being assessed by ≤ 3 studies. The most frequently validated system was the one from Meggitt‐Wagner, but the articles validating this system focused mainly on the association between the different grades and amputation. Clinical outcomes were not standardized but included ulcer‐free survival, ulcer healing, hospitalisation, limb amputation, mortality, and cost. Conclusion: Despite the limitations, this systematic review provided sufficient evidence to support recommendations on the use of six particular systems in specific clinical scenarios. [ABSTRACT FROM AUTHOR]
Copyright of Diabetes/Metabolism Research & Reviews is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Complementary Index
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  Data: Classification of foot ulcers in people with diabetes: A systematic review.
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  Data: <searchLink fieldCode="AR" term="%22Monteiro‐Soares%2C+Matilde%22">Monteiro‐Soares, Matilde</searchLink><br /><searchLink fieldCode="AR" term="%22Hamilton%2C+Emma+J%2E%22">Hamilton, Emma J.</searchLink><br /><searchLink fieldCode="AR" term="%22Russell%2C+David+A%2E%22">Russell, David A.</searchLink><br /><searchLink fieldCode="AR" term="%22Srisawasdi%2C+Gulapar%22">Srisawasdi, Gulapar</searchLink><br /><searchLink fieldCode="AR" term="%22Boyko%2C+Edward+J%2E%22">Boyko, Edward J.</searchLink><br /><searchLink fieldCode="AR" term="%22Mills%2C+Joseph+L%2E%22">Mills, Joseph L.</searchLink><br /><searchLink fieldCode="AR" term="%22Jeffcoate%2C+William%22">Jeffcoate, William</searchLink><br /><searchLink fieldCode="AR" term="%22Game%2C+Fran%22">Game, Fran</searchLink>
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  Data: Diabetes/Metabolism Research & Reviews; Mar2024, Vol. 40 Issue 3, p1-32, 32p
– Name: Subject
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  Group: Su
  Data: <searchLink fieldCode="DE" term="%22PEOPLE+with+diabetes%22">PEOPLE with diabetes</searchLink><br /><searchLink fieldCode="DE" term="%22MEDICAL+personnel%22">MEDICAL personnel</searchLink><br /><searchLink fieldCode="DE" term="%22PRESSURE+ulcers%22">PRESSURE ulcers</searchLink><br /><searchLink fieldCode="DE" term="%22PERIPHERAL+vascular+diseases%22">PERIPHERAL vascular diseases</searchLink><br /><searchLink fieldCode="DE" term="%22DIABETIC+foot%22">DIABETIC foot</searchLink><br /><searchLink fieldCode="DE" term="%22MEDICAL+communication%22">MEDICAL communication</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Classification and scoring systems can help both clinical management and audit the outcomes of routine care. Aim: This study aimed to assess published systems used to characterise ulcers in people with diabetes to determine which should be recommended to (a) aid communication between health professionals, (b) predict clinical outcome of individual ulcers, (c) characterise people with infection and/or peripheral arterial disease, and (d) audit to compare outcomes in different populations. This systematic review is part of the process of developing the 2023 guidelines to classify foot ulcers from the International Working Group on Diabetic Foot. Methods: We searched PubMed, Scopus and Web of Science for articles published up to December 2021 which evaluated the association, accuracy or reliability of systems used to classify ulcers in people with diabetes. Published classifications had to have been validated in populations of >80% of people with diabetes and a foot ulcer. Results: We found 28 systems addressed in 149 studies. Overall, the certainty of the evidence for each classification was low or very low, with 19 (68%) of the classifications being assessed by ≤ 3 studies. The most frequently validated system was the one from Meggitt‐Wagner, but the articles validating this system focused mainly on the association between the different grades and amputation. Clinical outcomes were not standardized but included ulcer‐free survival, ulcer healing, hospitalisation, limb amputation, mortality, and cost. Conclusion: Despite the limitations, this systematic review provided sufficient evidence to support recommendations on the use of six particular systems in specific clinical scenarios. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label:
  Group: Ab
  Data: <i>Copyright of Diabetes/Metabolism Research & Reviews is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1002/dmrr.3645
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        Text: English
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      – SubjectFull: PRESSURE ulcers
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      – SubjectFull: DIABETIC foot
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              Text: Mar2024
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