Using DIRECT Wound Assessment to Predict Limb Salvage and Provide Prognosis of Diabetic Foot Ulcers

전동근; 권용석; 배재현; 이명철; Jee Nam Kim; Hyun Gon Choi; Dong Hyeok Shin

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자료유형: 학술저널

저자정보: 전동근 (Department of Plastic and Reconstructive Surgery Konkuk University School of Medicine) 권용석 (Department of Plastic and Reconstructive Surgery Konkuk University School of Medicine) 배재현 (Department of Plastic and Reconstructive Surgery Konkuk University School of Medicine) 이명철 (Department of Plastic and Reconstructive Surgery Konkuk University School of Medicine) Jee Nam Kim (Department of Plastic and Reconstructive Surgery Konkuk University School of Medicine) Hyun Gon Choi (Department of Plastic and Reconstructive Surgery Konkuk University School of Medicine) Dong Hyeok Shin (Department of Plastic and Reconstructive Surgery Konkuk University School of Medicine)

저널정보: 대한창상학회 Journal of Wound Management and Research Journal of Wound Management and Research Vol.17 No.1

발행연도: 2021.1

수록면: 9 - 18 (10page)

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Background: Many wound assessment systems including the Wagner classification and University of Texas (UT) grading system have been previously described. The authors of this study applied the DIRECT (Debridement of necrosis, Infection control, Revascularization, Exudate control, Chronicity, and Top surface) wound coding system for initial assessment of diabetic foot ulcers (DFUs) to predict limb salvage and prognosis. Methods: From January 2016 to February 2020, a total of 169 first-time DFU patients were retrospectively evaluated using the DIRECT wound coding assessment system. DFUs were followed up for at least 6 months, and scores in each component of the coding system according to final limb status were statistically evaluated. The coding assessment’s ability to predict major amputation was compared to those of the Wagner classification and the UT grading system. Results: Subjects were divided into complete healing (n=80, 47.3%), not healed (n=71, 42%), and amputation (n=18, 10.7%) groups. The mean values of each component of DIRECT assessment for the complete healing/amputation groups were D 0.86/1.56 (P<0.001), I 0.46/0.89 (P=0.001), R 0.65/0.94 (P=0.014), E 1.15/1.56 (P=0.049), C 0.69/0.89 (P=0.086), T 0.53/0.72 (P=0.13) and the sum was 3.140/4.741 (P<0.001). The area under the receiver operating characteristic curve of the DIRECT, Wagner, and UT grading systems was 0.722, 0.603, and 0.663, respectively. Conclusion: The DIRECT coding system shows a greater association with prediction of amputation or complete healing, compared with the Wagner and UT wound classification systems. This more accurate wound assessment system will be helpful in predicting prognosis and planning treatments.

#Amputation #Diabetic foot #Limb salvage #Wound healing

참고문헌 (11)

참고문헌 신청

Armstrong DG / 2017 / Diabetic foot ulcers and their recurrence / N Engl J Med 376:2367~2375

Brownrigg JR / 2016 / Performance of prognostic markers in the prediction of wound healing or amputation among patients with foot ulcers in diabetes : a systematic review / Diabetes Metab Res Rev 32(Suppl 1):128~135

Jun YJ / 2016 / A mobile application for wound assessment and treatment : findings of a user trial / Int J Low Extrem Wounds 15:344~353

Oyibo SO / 2001 / A comparison of two diabetic foot ulcer classification systems : the Wagner and the University of Texas wound classification systems / Diabetes Care 24:84~88

Armstrong DG / 1998 / Validation of a diabetic wound classification system : the contribution of depth, infection, and ischemia to risk of amputation / Diabetes Care 21:855~859

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