A comparative study between Wagner’s classification and new wound based diabetic foot ulcer severity score

Abstract

Background: Diabetes is considered to be one of the most common health problems all over the world in 21st century. In fact, it has been coined the ‘Black death of the 21st century due to its stark similarities with the 14th century plague in terms of rapid increase in its prevalence, morbidity and mortality. According to WHO, the number of diabetic patients in 2000 reached to 171 million and was predicted to increase to 380 million by 2020. The Indian diabetic population is expected to increase to 57 million by the year 2025. Diabetic foot ulcers are one of the most distressing complications of diabetes affecting around 15% of people with diabetes. The annual incidence of diabetic foot ulcers is around 3% and the reported incidence in U.S and U.K studies ranges as high as 10%. It has been reported that 85% of the lower limb amputations in diabetic patients are preceded by foot ulceration. These systems are variously based on the site of ulcer, depth, and presence or absence of neuropathy, infection and peripheral arterial disease and have been used to compare the outcomes. Diabetic ulcer severity score (DUSS) is one of the latest wound-based systems of classification. However, there is paucity of enough data to validate whether DUSS system is better as compared to other established and commonly used scoring system like Wagner’s classification. Hence, it was decided to validate DUSS scoring system with Wagner’s classification by comparing both keeping in view outcome of the disease. Methods: Patients admitted under various surgical units from January 2022-January 2023, at Mamata medical college and hospital, Khammam. Total of 40 diabetic patients with diabetic foot ulcers irrespective of their duration, attending surgical outpatient clinic or admitted into the hospital (Mamata general hospital) were recruited into the study based on the inclusion and exclusion criteria mentioned below. Results: DUSS score and Wagner’s score were found to be almost equal in evaluating the scores for treatment as p value was found to be statistically significant (p=0.001) and by KAPPA stats there was an absolute agreement (score 1) between DUSS and Wagner’s scoring system. Conclusions: The new severity scoring system (DUSS) is equal to gold standard Wagner’s scoring system for predictive analysis which also provides an early idea regarding hospital admission, local surgery and health care costs. Since this scoring system 72 can be easily applied in daily clinical practice, it may be suitable in estimating putative healthcare costs.