Comparison of the clinical value of the Wagner grading and the University of Texas diabetic wound classification system

Abstract

Objective To evaluate the effect of Wagner grading and the University of Texas diabetic wound classification system on the prognosis of diabetic foot ulcer. Methods From March 1999 to September 2009, a total of 242 newly-diagnosed diabetic foot ulcer patients (with a ulcer course of 3 days to two weeks) were involved in this retrospective cohort study, there were 145 males and 97 females aged 19-78 years with a diabetes course of 0.5-27.0 years. The size of the ulcer, clinical evidence of infection, ischemia and neuropathy were recorded. Each ulcer was graded using both the Wagner grading and the University of Texas diabetic foot classification system. The patients were followed-up for 6 months. Once ulcer healed completely or a lower-limb amputation was performed, the outcome was noted and the patients was deemed to have completed the study. The χ2 test for trend, Kaplan-Meier survival analysis and log-rank test were used to assess the capability of grading and stage to predict healing and increased risk of amputation within the study period. Results Among the 242 patients with recently diagnosed diabetic foot ulcers, 54.9% (133 patients) were neuropathic, 34.3% (83 patients) were neuroischemic, and 8.7% (21 patients) had no identified underlying factors. Lower-limb amputations were performed in 20.7% (50 cases) of the conditions, whereas 147 cases (60.7%) healed within 6 months and 14% (34 cases) not healed till the study ended, and 3 patients(5.4%) died. The Wagner grade showed a significant positive trend with increased number of amputation (χ2=79.6420, P 0.05) when compared with those ulcers without infection and ischemia. The log-rank test showed that healing times were not significantly different in patients with ulcer in different Wagner grade(χ2=4.761, df=2, P>0.05) or in different grade in the University of Texas wound classification system (χ2=5.452, df=2, P>0.05), but there was a significant stepwise increase in healing time with each stage of the Texas system(χ2=11.234, df=3, P<0.05). Conclusions The University of Texas wound classification system is associated with increased risk of amputation and prolonged ulcer time compared with the Wagner system, and it can be a better predictor of the prognosis. Key words: Diabetic foot; Ulcer; Wagner grading wound classification system; University of Texas diabetic wound classification system