Abstract
BackgroundDiabetic foot infections are common, serious, and varied. Diagnostic and treatment strategies are correspondingly diverse. It is unclear how patients are managed in actual practice and how outcomes might be improved. Clarification will require study of large numbers of patients, such as are available in medical databases. We have developed and evaluated a system for identifying and classifying diabetic foot infections that can be used for this purpose.MethodsWe used the (VA) Diabetes Epidemiology Cohorts (DEpiC) database to conduct a retrospective observational study of patients with diabetic foot infections. DEpiC contains computerized VA and Medicare patient-level data for patients with diabetes since 1998. We determined which ICD-9-CM codes served to identify patients with different types of diabetic foot infections and ranked them in declining order of severity: Gangrene, Osteomyelitis, Ulcer, Foot cellulitis/abscess, Toe cellulitis/abscess, Paronychia. We evaluated our classification by examining its relationship to patient characteristics, diagnostic procedures, treatments given, and medical outcomes.ResultsThere were 61,007 patients with foot infections, of which 42,063 were classifiable into one of our predefined groups. The different types of infection were related to expected patient characteristics, diagnostic procedures, treatments, and outcomes. Our severity ranking showed a monotonic relationship to hospital length of stay, amputation rate, transition to long-term care, and mortality.ConclusionsWe have developed a classification system for patients with diabetic foot infections that is expressly designed for use with large, computerized, ICD-9-CM coded administrative medical databases. It provides a framework that can be used to conduct observational studies of large numbers of patients in order to examine treatment variation and patient outcomes, including the effect of new management strategies, implementation of practice guidelines, and quality improvement initiatives.
Highlights
Diabetic foot infections are common, serious, and varied
We report the construction of a classification system for diabetic foot infections that is unique, in that it is expressly designed for use with ICD-9-CM coded administrative data and is derived from a very large number of patients
Our data came from the national Veterans Health Administration (VA) Diabetes Epidemiology Cohorts (DEpiC), a linked, computerized research database that serves as a registry of virtually all Veterans Health Administration (VHA) patients with diabetes
Summary
Diabetic foot infections are common, serious, and varied. Diagnostic and treatment strategies are correspondingly diverse. It is unclear how patients are managed in actual practice and how outcomes might be improved. Clarification will require study of large numbers of patients, such as are available in medical databases. Diagnostic and treatment strategies are correspondingly varied. A very large study would be needed to evaluate how these infections are managed in actual practice and how outcomes might be altered by different treatment strategies. The use of computerized medical databases could address this problem Such databases often include very large numbers of patients and are an important and increasing source of information for use in medical research. Applicable methods are needed to identify and categorize patients with diabetic foot infections
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