Clinical utility of diabetic ulcer severity score in patients with diabetic foot ulcers – A prospective study

Abstract

Background: The most common reason for hospitalisation for diabetic people is diabetic foot ulcer (DFU). For diabetic foot ulcers, a variety of scoring systems and classifications are available with the goal of comparing treatment options and long-term results. Aim of the study was to evaluate the effectiveness of the diabetic ulcer severity score, a wound-based clinical scoring system for diabetic foot ulcers, in predicting clinical outcomes. Materials and method: A prospective study was conducted on 65 diabetic ulcer patients. DUSS was applied during the admission. The DUSS consists of four clinical variables: 1) pedal pulses, 2) bone probing, 3) ulcer site, and 4) ulcer number. These wounds were scored as 0, 1, 2, 3, or 4. All patients received standard care in accordance with a protocol. The outcome of treatment was recorded. Results: In this prospective study of 65 patients with diabetic foot ulcers, most common age group affected was between 51-70 years. Mean duration of diabetes was 8.13±4.28 years. Most commonly ulcers were of DUSS score 1. Of the 65 patients, 36 (55.38%) got conservative care, including wound debridement, 14 (21.54%) underwent skin grafting, and 15 (23.08%) underwent amputation. DFU with DUSS score 0 healed by 2 weeks, score 3 and 4 healed mostly only after surgical intervention. Comparison of amputation based on DUSS score showed statistical significance. The mean healing time was found to be 108.8±43.7 days. Conclusion: This study conclude that DUSS system is a wound based diagnostic procedure to predict healing, amputation or need for surgery by combining the four sign in a safe manner. Keywords: amputation; diabetes mellitus; duss scoring system; foot ulcer