Abstract
BackgroundAcute Charcot Neuroarthropathy (CN) is a destructive condition that is characterised by acute fractures, dislocations and joint destruction in the weight-bearing foot. The acute phase is often misdiagnosed and can rapidly lead to devastating health outcomes. Early diagnosis and management of CN is imperative to attenuate progression of this condition. Consequently, timely evidence-based assessment, diagnosis and management of acute CN is imperative.ObjectiveTo identify the factors that impact the delivery of evidence-based care in assessment, diagnosis and management of people with acute CN.MethodSystematic searches were conducted in four databases to identify studies in English that included factors that impact the delivery of evidence-based care in the assessment, diagnosis and management of people with acute CN. Articles and consensus/guideline documents were assessed for inclusion by the researchers and disagreements were resolved through consensus. Additionally backward citation searching was used to source other potentially relevant documents. Information relevant to the research question was extracted and thematic analyses were performed using qualitative synthesis.ResultsThirty-two articles and four additional consensus/guideline documents were included for data extraction and analyses. Information related to the research question was of expert opinion using the National Health and Medical Research Council (NHMRC) Levels of Evidence guidelines. Themes explaining practices that deviated from evidence-based care in assessment, diagnosis and management of acute CN centred around patient, health professional and health organisation/environmental. Delay to diagnosis is particularly influenced by the patient’s knowledge of when to seek help, practitioner knowledge in knowing how to recognise and refer for appropriate immediate care, confusion in imaging and offloading and geographical and local health service resources to appropriately manage the condition.ConclusionIndividual and health professional awareness and geographical barriers are key challenges to the effective delivery of evidence-based assessment, diagnosis and management of people with acute CN. Acute CN represents a medical emergency warranting the need for expedited assessment, diagnosis and management by appropriately trained health professionals in the appropriate.
Highlights
Acute Charcot Neuroarthropathy (CN) is an end stage complication in people with a diagnosis of diabetes or other less common conditions that cause peripheral neuropathy [1]
Themes explaining practices that deviated from evidence-based care in assessment, diagnosis and management of acute CN centred around patient, health professional and health organisation/environmental
Acute CN represents a medical emergency warranting the need for expedited assessment, diagnosis and management by appropriately trained health professionals in the appropriate
Summary
Acute Charcot Neuroarthropathy (CN) is an end stage complication in people with a diagnosis of diabetes or other less common conditions that cause peripheral neuropathy [1]. It is a progressive complication of the neuropathic foot initially characterised by gross inflammation of the foot or ankle, redness, heat and bony destruction if left untreated [2]. What triggers the gross inflammatory process is not well understood, with research into gene expression and early detection methods for CN proving inconclusive [1] The clinical manifestations such as swelling, redness and changed structure of the foot in CN are more clearly recognised by trained health professionals once they occur and are clearly articulated in clinical guidelines to aid clinical decision-making [3]. Timely evidence-based assessment, diagnosis and management of acute CN is imperative
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