Diabetic ulcer severity score: clinical validation and outcome

Abstract

Background: Foot ulcers are a common complication of diabetes and represent a major source of morbidity. Variation in the clinical presentation of this disease has resulted in the paucity of evidence to guide optimal clinical management. A validated scoring system might help the clinicians and researchers in everyday assessment and management of patients or the development and assessment of new therapies. Diabetic ulcer severity score (DUSS) is one of the latest wound based system of classification which needs to be validated. The objective of this study was to clinically validate diabetic ulcer severity score with patient outcome. Methods: 100 patients were prospectively assessed from October 2012 to March 2014 for four clinical parameters - palpable pedal pulses absence (score 1) or presence (score 0), probing to bone yes (score 1) or no (score 0). The site of ulcer- toe (score 0) or foot (score 1) ulcer. Multiple ulcers scored as 1, single ulcers scored as 0. The DUSS was calculated by adding these to a maximum of 4. Wounds were followed-up until healing or amputation .Kaplan-Meier analysis; Chi- Square tests were used for statistical analysis. Results: Analyses showed a significantly higher probability of healing for patients with palpable pulses, no probing to bone, toe ulcers, and single ulcer. A decreasing probability of healing for absent pedal pulses, probing to bone, foot ulcers and multiple ulcers with increasing amputation rates. Conclusions: Lower DUSS score was strongly associated with healing and higher score with amputation.