Role of Perfusion, Extent, Depth, Infection and Sensation Scores in Determining the Outcome of Patients with Diabetic Foot Ulcers: A Prospective Cohort Study

Abstract

Introduction: Diabetes mellitus is a major public health problem in India. A Diabetic Foot Ulcer (DFU) is characterised by a full-thickness wound, skin necrosis, or gangrene below the ankle brought on by peripheral neuropathy or peripheral artery disease in diabetic patients. Numerous classification schemes have been put forth to classify and forecast the clinical outcomes of DFUs. The Perfusion, Extent, Depth, Infection and Sensation Score (PEDIS) classification system was developed to objectively categorise and define DFUs, facilitating communication between healthcare providers. Aim: To determine the utility of the PEDIS score in predicting the outcomes of patients with DFUs. Materials and Methods: The present single-centre prospective cohort study was conducted in the Department of General Surgery, Tezpur Medical College and Hospital, Tezpur, Assam, India, from August 1, 2022 to January 30, 2023, involving 60 patients. A PEDIS score was calculated and recorded for each patient. Patients were then classified into low-score (0-7) or high-score (8-12) groups and followed up for six months. Outcomes were categorised as healed, unhealed, amputated, or deceased. Categorical data were presented as percentages and compared using the Chi-square test. The Receiver Operating Characteristic (ROC) curve was utilised to determine the cut-off value. A p-value <0.05 was considered statistically significant. Results: The mean±Standard Deviation (SD) age at presentation was 49±14 years with a male preponderance (Male:Female= 2:1). Of all patients, 40 (66.67%) were healed following debridement and dressing, 11 (18.3%) had non healing ulcers, 5 (8.3%) underwent amputation, and 4 (6.67%) expired. Thirty-four (85%) of healed patients had PEDIS scores below eight, and 7 (63.6%) of patients with non healing ulcers had high PEDIS scores. Those undergoing amputation, 4 (80%) had high PEDIS scores and all deceased patients had high PEDIS scores. Conclusion: Patients with DFUs who had higher PEDIS scores were more likely to develop complications such as non healing ulcers or require amputation. Therefore, the PEDIS score is a valuable system in clinical practice and can be uniformly applied to compare the outcomes of DFUs.