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Novel System Helps Grade Diabetic Foot Ulcer Severity

Posted: Wednesday, May 24, 2006

A new wound-based measurement system, the diabetic ulcer severity score (DUSS), helps categorize such ulcers and their likely outcome.

As senior investigator Dr. Stephan Coerper stated that, the DUSS score will have an impact on referring patients to special centers. "Because the score is easily assessable, every physician can use it and will then know when a patient has a bad prognosis and should be treated by specialists."

Dr. Coerper and colleagues at the University of Tubingen note that there is a lack of scientifically validated severity scores, usable in daily clinical practice, with which to anticipate the chances of healing and the possibility of amputation in patients with diabetic foot ulcers.

In order to develop the DUSS, the researchers prospectively evaluated 1000 patients with ulcers below the ankle. Four clinically defined parameters were employed and were scored as 1 or 0 depending on their particular severity, presence, absence or location.

The items consisted of presence (scored 1) or absence (scored 0) of palpable pedal pulses, wound depth down to bone (1) or shallower (0), ulcer location on toe (0) or foot (1), and the presence (1) or absence (0) of multiple ulcers. The DUSS score was thus a maximum of 4.

In order to help validate the system, the patients were followed for a year or, if earlier, until healing or amputation. The researchers established that all four parameters had an independent impact on wound healing.

The team found that there was a significantly higher probability of healing in patients without multiple ulcers and with palpable pulses, no probing to the bone and toe ulcers.

There was a decreased probability of healing and an increased rate of amputation in patients with a high DUSS score. In fact, an increase in DUSS score of 1 point reduced the chance of healing by 35%.

Also, although the association did not reach significance, the probability of major amputation ranged from none in patients with a DUSS of 0 to 11.2% in those with a score of 3.

Dr. Coerper added that "treatment costs depend on length of treatment and hospitalization as well as on surgery. Therefore this score might have an impact on predicting treatment costs of patients."

Source: Diabetes In Control: Diabetes Care 2006;29:988-992