Clasificaciones de lesiones en pie diabético II. El problema permanece

  1. Héctor González de la Torre
  2. Miriam Berenguer Pérez
  3. Abián Mosquera Fernández
  4. María Luana Quintana Lorenzo
  5. Raquel Sarabia Lavín
  6. José Verdú Soriano
Gerokomos: Revista de la Sociedad Española de Enfermería Geriátrica y Gerontológica

ISSN: 1134-928X

Year of publication: 2018

Volume: 29

Issue: 4

Pages: 197-209

Type: Article

Export: RIS


ABSTRACT Introduction: Various classification systems have been published for diabetic foot ulcers, although none of the proposed systems has been accepted by the scientific community as the system to be used by all, and this is due to multiple reasons. Objectives: To give visibility to the new systems of diabetic foot classification that have emerged in recent years, as well as to compare them with the systems already known previously. Methods: Bibliographic search in the SCOPUS, Pubmed/Medline, WOS, CINHAL, Cochrane and CUIDEN databases. The search equation used was the boolean combination of the MeSH terms “diabetic foot AND classification”. The search was conducted between 1 February 2018 and 30 March 2018. Results: There are 25 classification systems for diabetic foot ulcers, which can be divided into classification-severity systems or healing-amputation prediction systems. Very few systems have been properly validated. Conclusions: The choice of the diabetic foot system to be used will be conditioned by aspects such as the assistencial scene, the available resources or the objectives pursued. In recent years, the use of systems with a predictive approach has been preferred over systems with a descriptive approach.

Bibliographic References

  • Wild, S,Roglic, G,Green, A,Sicree, R,Kig, . (2004). Global prevalence of diabetes estimates: for the year 2000 and projections for 2030. Diabetes Care. 27. 1047
  • Marinel·lo Roura, J,Verdú Sorian. (2018). Conferencia nacional de consenso sobre las úlceras de la extremidad inferior (C:O.N.U.E.I.). Ergon. Madrid.
  • (2011). International Consensus on the Diabetic Foot & Practical and Specific Guidelines on the Management and Prevention of the Diabetic Foot. 6th International Symposium on the Diabetic Foot.
  • Lipsky, BA,Aragón-Sánchez, J,Diggle, M,Embil, J,Kono, S,Lavery, L,Peters, E. (2016). IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev. 32. 45-74
  • Prompers, L,Huijberts, M,Apelqvist, J,Jude, E,Piaggesi, A,Bakker, . (2007). High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia. 50. 18-25
  • Guest, JF,Ayoub, N,McIlwraith, T,Uchegbu, I,Gerrish, A,Weidlich, . (2017). Health economic burden that different wound types impose on the UK’s National Health Service. Int Wound J. 14. 322
  • Group, T. (2000). Epidemiology of lower extremity amputation in centres Europe, north America and East Asis. The global lower extremity amputation group. B J Surg. 87. 328
  • (2003). Peripheral Arterial Disease in people with diabetes. Diabetes Care. 26. 3333
  • González de la Torre, H,Mosquera Fernández, A,Quintana Lorenzo, ML,Perdomo Pérez, E,Quintana Montesdeoca, M. (2012). Clasificaciones de Pie diabético. Un problema no resuelto. Gerokomos. 23. 75-87
  • Game, . (2016). Classification of diabetic foot ulcers. Diabetes Metab Res Rev. 32. 186
  • Monteiro-Soares, M,Martins-Mendes, D,Vaz-Carneiro, A,Dinis-Ribeiro, . (2015). Lower-limb amputation following foot ulcers in patients with diabetes: classification systems, external validation and comparative analysis. Diabetes Metab Res Rev. 31. 515
  • Martínez-De Jesús, F. (2010). A checklist system to score healing progress of diabetic foot ulcers. Int J Lower Extremity Wounds. 9. 74-83
  • International Consensus on the Diabetic Foot & Practical Guidelines on the Management and Prevention of the Diabetic Foot 2007. IWGDF-Consultative Section of the IDF (International Diabetes Federation).
  • Martínez-De Jesús, FR,González-Medina, MF,Martínez Mendiola, FN,Jiménez Godínez, R,Gutiérrez-Aguilar, . (2012). Clasificación de San Elián para el seguimiento de las úlceras de pie diabético y su relevancia terapéutica. Rev Latinoam Cir. 2. 31
  • Margolis, DJ,Allen-Taylor, L,Hoffstad, O,Berlin, J. (2002). Diabetic neuropathic foot ulcers: the association of wound size, wound duration, and wound grade on healing. Diabetes Care. 25. 1835
  • Margolis, DJ,Allen-Taylor, L,Hoffstad, O,Berlin, J. (2003). Diabetic neuropathic foot ulcers: predicting which ones will not heal. Am J Med. 115. 627
  • Margolis, DJ,Allen-Taylor, L,Hoffstad, O,Berlin, J. (2005). Diabetic neuropathic foot ulcers and amputation. Wound Repair Regen. 13. 230
  • Terashi, H,Kitano, I,Tsuji, . (2011). Total management of diabetic foot ulcerations--Kobe classification as a new classification of diabetic foot wounds. Keio J Med. 60. 17-21
  • Mills Sr, JL,Conte, MS,Armstrong, DG,Pomposelli, FB,Schanzer, A,Sidawy, A. (2014). The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on Wound, Ischemia, and foot Infection (WIfI). J Vasc Surg. 59. 220
  • Lavery, LA,Armstrong, DG,Murdoch, DP,Peters, EJG,Lipsky, B. (2007). Validation of the infectious diseases Society of America's diabetic foot infection classification system. Clin Infect Dis. 44. 562
  • Jain, AK. (2015). A Simple New Classification for Diabetic Foot Ulcers. Medicine Science. 4. 2109
  • Jain, AKC,Joshi, . (2013). Diabetic Foot Classifications: Review of Literature. Medicine Science. 2. 715
  • Jain, AK. (2017). Amit Jain's coding system for diabetic foot ulcer. International J Med Sci Clin Invention. 4. 3126
  • Arisandi, D,Oe, M,Roselyne Yotsu, R,Matsumoto, M,Ogai, K,Nakagami, . (2016). Evaluation of validity of the new diabetic foot ulcer assessment scale in Indonesia. Wound Repair Regen. 24. 876
  • Barber, . (2008). A clinically relevant wound assessment method to monitor healing progression. Ostomy Wound Manage. 54. 42
  • Thomas, DR,Rodeheaver, GT,Bartolucci, AA,Franz, RA,Sussman, C,Ferrell, B. (1997). Pressure ulcer scale for healing: derivation and validation of the PUSH tool. The PUSH Task Force. Adv Skin Wound Care. 10. 96-101
  • Monteiro-Soares, M,Martins-Mendes, D,Vaz-Carneiro, A,Sampaio, S,Dinis-Ribeiro, . (2014). Classification systems for lower extremity amputation prediction in subjects with active diabetic foot ulcer: a systematic review and meta-analysis. Diabetes Metab Res Rev. 30. 610
  • Lipsky, BA,Weigelt, JA,Sun, X,Johannes, RS,Derby, KG,Tabak, Y. (2011). Developing and validating a risk score for lower-extremity amputation in patients hospitalized for a diabetic foot infection. Diabetes Care. 34. 1695
  • Tardivo, JP,Baptista, MS,Correa, JA,Adami, F,Pinhal, M. (2015). Development of the Tardivo Algorithm to Predict Amputation Risk of Diabetic Foot. PLoS One. 10. 0135707
  • Monteiro-Soares, M,Dinis-Ribeiro, . (2016). A new diabetic foot risk assessment tool: DIAFORA. Diabetes Metab Res Rev. 32. 429
  • Meggitt, . (1976). Surgical management of the diabetic foot. Br J Hosp Med. 16. 227-332
  • Vela, MP,Soria, L,Arana-Arri, E,Gaztambide-Saez, . (2017). Evaluation of the WIfI classification system in older patients with diabetes. Wounds International. 8. 23
  • Haryanto, H,Arisandi, D,Suriadi, S,Imran, I,Ogai, K,Sanada, . (2017). Relationship between maceration and wound healing on diabetic foot ulcers in Indonesia: a prospective study. Int Wound J. 14. 516
  • Restrepo, JC,Verdu, . (2012). Development of a wound healing index for chronic wound. EMWA J. 12. 39-46
  • Jeon, BJ,Choi, HJ,Kang, JS,Tak, MS,Park, E. (2017). Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation. Int Wound J. 14. 537
  • Parisi, MC,Zantut-Wittmann, DE,Pavin, EJ,Machado, H,Nery, M,Jeffcoate, W. (2008). Comparison of three systems of classification in predicting the outcome of diabetic foot ulcers in a Brazilian population. Eur J Endocrinol. 159. 417
  • Bravo-Molina, A,Linares-Palomino, JP,Vera-Arroyo, B,Salmerón-Febres, LM,Ros-Díe, . (2018). Inter-observer agreement of the Wagner, University of Texas and PEDIS classification systems for the diabetic foot syndrome. Foot Ankle Surg. 24. 60
  • Forsythe, RO,Ozdemir, BA,Chemla, ES,Jones, KG,Hinchliffe, R. (2016). Interobserver Reliability of Three Validated Scoring Systems in the Assessment of Diabetic Foot Ulcers. Int J Low Extrem Wounds. 15. 213
  • Huang, Y,Xie, T,Cao, Y,Wu, M,Yu, L,Lu, . (2015). Comparison of two classification systems in predicting the outcome of diabetic foot ulcers: the Wagner grade and the Saint Elian Wound score systems. Wound Repair Regen. 23. 379
  • Santema, TB,Lenselink, EA,Balm, R,Ubbink, D. (2016). Comparing the Meggitt-Wagner and the University of Texas wound classification systems for diabetic foot ulcers: inter-observer analyses. Int Wound J. 13. 1137
  • Abbas, ZG,Lutale, JK,Game, FL,Jeffcoate, W. (2008). Comparison of four systems of classification of diabetic foot ulcers in Tanzania. Diabet Med. 25. 134
  • Chuan, F,Tang, K,Jiang, P,Zhou, B,He, . (2015). Reliability and validity of the perfusion, extent, depth, infection and sensation (PEDIS) classification system and score in patients with diabetic foot ulcer. PLoS One. 10. 0124739
  • Armstrong, DG,Peters, EJ. (2001). Classification of wounds of the diabetic foot. Curr Diab Rep. 1. 233
  • Buggy, A,Moore, . (2017). The impact of the multidisciplinary team in the management of individuals with diabetic foot ulcers: a systematic review. J Wound Care. 26. 324
  • Wannous, H,Treuillet, S,Lucas, . (2007). Supervised tissue classification from color images for a complete wound assessment tool. Conf Proc IEEE Eng Med Biol Soc. 6032
  • Ahmad Fauzi, MF,Khansa, I,Catignani, K,Gordillo, G,Sen, CK,Gurcan, M. (2015). Computerized segmentation and measurement of chronic wound images. Comput Biol Med. 60. 74-85
  • Mukherjee, R,Manohar, DD,Das, DK,Achar, A,Mitra, A,Chakraborty, . (2014). Automated tissue classification framework for reproducible chronic wound assessment. Biomed Res Int. 2014. 851582
  • Deschamps, K,Matricali, GA,Roosen, P,Desloovere, K,Bruyninckx, H,Spaepen, . (2013). Classification of forefoot plantar pressure distribution in persons with diabetes: a novel perspective for the mechanical management of diabetic foot?. PLoS One. 8. 79924
  • Deschamps, K,Matricali, GA,Desmet, D,Roosen, P,Keijsers, N,Nobels, . (2016). Efficacy measures associated to a plantar pressure based classification system in diabetic foot medicine. Gait Posture. 49. 168
  • Gibbons, G,Elipoulos, . (1984). Management of the Diabetic Foot Problems. Saunders. Philadelphia: PA.
  • Pecoraro, RE,Reiber, G. (1990). Classification of wounds in diabetic amputees. Wounds. 2. 65-73
  • Brodsky, J. (2008). Levin, O´neal. El pie diabético. 7. Elsevier. Barcelona.
  • Lavery, LA,Armstrong, DG,Harkless, L. (1996). Classification of Diabetic Foot Wounds. J Foot Ankle Surg. 35. 528
  • Laing, . (1998). The development and complications of diabetic foot ulcers. Am J Surg. 176. 11
  • Macfarlane, RM,Jeffcoate, W. (1999). Classification of diabetic foot ulcers: the S(AD) SAD system. Diabetic Foot. 2. 123
  • Treece, KA,Macfarlane, RM,Pound, P,Game, FL,Jeffcoate, W. (2004). Validation of a system of foot ulcer classification in diabetes mellitus. Diabet Med. 21. 987
  • Foster, A,Edmonds, . (2000). Simple staging system: A tool for diagnosis and management. Diabetic Foot. 3. 56-61
  • Acker, K van,Block, C de,Abrams, P,Bouten, A,Leeuw, I de,Droste, . (2002). The choice of diabetic foot ulcer classification in relation to the final. Outcome Wounds. 14. 16-25
  • Younes, NA,Albsoul, A. (2004). The DEPA scoring system and its correlation with the healing rate or diabetic foot ulcers. J Foot Ankle Surg. 43. 209
  • Strauss, MB,Aksenov, I. (2005). Evaluations of diabetic wound classifications and a new wound score. Clin Orthop Relat Res. 439. 79-86
  • Beckert, S,Witte, M,Wicke, C,Königsrainer, A,Coerper, . (2006). A new wound-based severity score for diabetic foot ulcers: A prospective analysis of 1,000 patients. Diabetes Care. 29. 988
  • Beckert, S,Pietsch, AM,Küper, M,Wicke, C,Witte, M,Königsrainer, . (2009). M A.I.D: a prognostic score estimating probability of healing in chronic lower extremity wounds. Ann Surg. 249. 677
  • Ince, P,Abbas, ZG,Lutale, JK,Basit, A,Ali, SM,Chohan, . (2008). Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents. Diabetes Care. 31. 964
  • Edsberg, LE,Black, JM,Goldberg, M,McNichol, L,Moore, L,Sieggreen, . (2016). Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System. J Wound Ostomy Continence Nurs. 43. 585
  • García-Fernández, FP,Soldevilla-Agreda, JJ,Pancorbo-Hidalgo, PL,Verdú-Soriano, J,López-Casanova, P,Rodríguez Palma, . (2014). Clasificación-categorización de las lesiones relacionadas con la dependencia. Grupo nacional para el estudio y asesoramiento de úlceras por presión y heridas crónicas. Logroño.