Abstract
AimsTo validate the perfusion, extent, depth, infection and sensation (PEDIS) classification system and to make the clinical practice easier, we created a score system and compared this system with two previously published common score systems.MethodsA retrospective cohort study was conducted on patients with diabetic foot ulcer (DFU) attending our hospital (n=364) from May 2007 to September 2013. Participants’ characteristics and all variables composing the PEDIS classification system were assessed.ResultsDuring a median follow-up of 25 months (range 6-82), ulcers healed in 217 of the 364 patients (59.6%), remained unhealed in 37 patients (10.2%), and were resolved by amputation in 62 patients (17.0%); 48 patients (13.2%) died. When measured using the PEDIS classification system, the outcome of DFU deteriorated with increasing severity of each subcategory. Additionally, longer ulcer history, worse perfusion of lower limb, a larger extent of the ulcer, a deeper wound, more severe infection, and loss of protective sensation were independent predictors of adverse outcome. More importantly, the new PEDIS score system showed good diagnostic accuracy, especially when compared with the SINBAD and Wagner score systems.ConclusionsThe PEDIS classification system, which encompasses relevant variables that contribute to the outcome of DFU and has excellent capacity for predicting the ulcer outcome, demonstrated acceptable accuracy. The PEDIS classification system might be useful in clinical practice and research both for the anticipation of health care costs and for comparing patient subgroups.
Highlights
Diabetic foot ulcer (DFU) is a full-thickness wound, skin necrosis or gangrene below the ankle induced by peripheral neuropathy or peripheral arterial disease in patients with diabetes
When measured using the PEDIS classification system, the outcome of DFU deteriorated with increasing severity of each subcategory
The PEDIS classification system, which encompasses relevant variables that contribute to the outcome of DFU and has excellent capacity for predicting the ulcer outcome, demonstrated acceptable accuracy
Summary
Diabetic foot ulcer (DFU) is a full-thickness wound, skin necrosis or gangrene below the ankle induced by peripheral neuropathy or peripheral arterial disease in patients with diabetes. To categorize and define DFU objectively and facilitate communication between health-care providers, the International Working Group of the Diabetic Foot (IWGDF) developed the Perfusion, Extent, Depth, Infection and Sensation (PEDIS) classification system in which all DFUs are classified according to five categories: perfusion, extent/size, depth/tissue loss, infection and sensation. These categories were considered to be the most relevant pathogenesis of the development of DFU. The PEDIS classification system was developed primarily for research and has not yet been validated in clinical practice regarding prognosis [8]
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