New Test Predicts Which Ulcers Will Heal With Standard Therapy
posted 12/27/03
Foot ulcers are a common problem for diabetics, and now researchers have come up with a simple scoring system that predicts which ulcers will heal with standard therapy.

In general, ulcers that are larger, deeper and of longer duration are less likely to heal than others.

To develop their scoring system, Dr. David J. Margolis and associates, from the University of Pennsylvania in Philadelphia, examined the outcomes of more than 27,000 diabetics with foot ulcers who were treated at one of 150 facilities between 1999 and 2000.

As they report in the American Journal of Medicine, all patients were diabetics with adequate blood flow, but poor nerve sensitivity in their feet. Treatment included good wound care, removal of dead tissue as needed, and the use of devices to keep pressure off the ulcer -- all of which are recommended by the American Diabetes Association.

The authors evaluated outcomes based on gender, age, number of ulcers as well as ulcer duration, size and depth. However, the strongest factors affecting outcome were the latter three, so the researchers focused on these in creating their scoring system.

For each of the three parameters -- ulcer duration, size, and depth -- the ulcers were graded as good or bad by assigning a score of 0 or 1, respectively. Therefore, the total score could range from 0 (the best) to 3 (the worst).

For patients with a score of 0, there was a 33 percent chance that their ulcer wouldn't heal by the 20th week of care, but for those with a score of 3, the chances of not healing rose to 79 percent. Further testing in a subgroup of patients confirmed these results.

The researchers believe their scoring system could be used in routine care to stratify patients for their chances of ulcer healing, and to intensify treatment in the riskiest cases.

Source: Diabetes In Control.com: American Journal of Medicine, December 3, 2003.

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