Abstract
The aim of this study is to create an evidence-based tool that guides the risk of amputation in diabetic foot patients. Hospital records of 301 diabetic foot patients were examined retrospectively for explanatory variables of foot amputation decisions. The study included all patients with a lower limb ulcer with a known history of diabetes mellitus or those diagnosed post-admission. The dataset was analyzed, and a risk scoring system was constructed using the decision tree algorithm, C5.0. Two classifiers, one simple and another complex, were constructed for predicting amputation outcome. Based on our evaluation, the most influential predictors for a decision to amputate are Doppler flow measurements and the Wagner grading of the ulceration. The simple classifier uses just these two parameters in determining risk. The results obtained show an accuracy of 96.4% in the primary group and an accuracy of 94% in the test group. The second classifier is a more complex computer-derived construct that showed 100% accuracy in the principle group and an accuracy of 96% during testing. In the present era of precision medicine, these two classifiers act as an accurate guide to the prognosis of the limb in patients with diabetic foot and can predict the risk of future amputation.
Highlights
Reviewed by: Dubravka Jurišic Eržen, Clinical Hospital Centre Rijeka, Croatia Tiffany M
Diabetic foot disease is a well-known complication of diabetes; its incidence rate is greater than all other complications combined [1, 2]
Our study focuses on attempting to determine those factors which affect the outcome of amputation in diabetic foot patients and create a prognostic scoring program to assess the degree of inevitability involved in amputation in the diabetic foot patient
Summary
Reviewed by: Dubravka Jurišic Eržen, Clinical Hospital Centre Rijeka, Croatia Tiffany M. Various classification systems have previously been proposed to estimate the risk of amputation in patients with diabetic foot disease. Pickwell et al [8] recently developed a risk stratification algorithm with greater sensitivity than the current PEDIS system: in a multicenter study of the IWGDF, they prospectively analyzed 575 patients and found periwound edema, foul smell, purulent exudates, deep ulcer, a positive probe-to-bone test, pretibial edema, fever, and increased C-reactive protein as risk factors for amputation; a risk scoring system was developed for predicting risk of amputation using these variables. Monteiro-Soares et al [13] conducted a meta-analysis of all the prevalent diabetic foot amputation risk classification systems available (15 in all) prior to 2013 and found Meggitt–Wagner, S(AD)SAD, and the Texas University Classification to be the most validated and accurate of the available systems. Monteiro-Soares and Dinis-Ribeiro [14] went on to develop their own DIAFORA tool (using a cohort of 293 patients); their algorithm comprises of eight variables used to construct point scoring system for amputation
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