Are we underestimating diabetes related lower-extremity amputation rates
Are we underestimating diabetes related lower-extremity amputation rates
复制标题
DOI：
10.2337/diacare.27.8.1892
复制
发表时间：
2004-08-01
期刊：
影响因子：
16.2
通讯作者：
Rayman, A
中科院分区：
文献类型：
--
作者：
Rayman, G;Krishnan, STM;Rayman, A
目的-本研究的目的是准确地确定下肢截肢的发病率使用前瞻性的数据收集和比较的结果，与那些通过回顾性的methods.RESEARCH设计和方法-这项研究进行了为期3年的时间在一个大的地区综合医院，覆盖明确定义和相对静态的人口。所有糖尿病住院患者足部问题进行了识别和随访，直到出院或死亡。所有相关病房的专科护士和足科医生每周两次收集患者的人口统计学和入院详情、病史、调查、手术、病史和病变病因。因此，可以识别所有接受截肢的受试者。为了进行比较，回顾性数据收集从医院编码活动数据库，手术室日志挂钩，麻醉数据库，和肢体填充records.RESULTS -该地区的总人口在2000年为337,859，其中9,183已知患有糖尿病。在3年调查期间，截肢总数为79例，其中45例为大截肢，34例为小截肢。在我们的本地人口中，调查期间的平均发病率（1997-2000年）所有截肢率为7.8/100，000一般人口和2.85/1，000糖尿病人口;大截肢率为4.5/100，000一般人口和1.62/1，000糖尿病人口;一般人群和1.23/1，000糖尿病人群的小截肢率。前瞻性调查检测到了各种回顾性方法识别的所有下肢截肢，然而，对于相反的情况，情况并非如此。所有的回顾性方法，包括最常用的（ICD-9和OPCS-4编码），未能检出前瞻性调查显示的所有病例（错误率范围为4.2%至90.6%），4.5 ~ 17.49/o的截肢被错误分类。本研究证明了前瞻性数据收集作为确定下肢截肢发生率的方法的优势，并强调了回顾性数据收集方法的局限性，低估了发病率特别是，手术室记录，这一直是许多调查的黄金标准，被发现是不可靠的。此外，我们还显示，在调查期间，重大截肢减少了47%。因此，我们建议将前瞻性审计纳入足部护理专家团队的活动中，作为评估和改善临床护理的一种手段。
OBJECTIVE - The objective of this study was to accurately determine the incidence of lower-extremity amputation using prospective data Collection and to compare the results,with those obtained by retrospective methods.RESEARCH DESIGN AND METHODS - The study was carried out over a 3-year period in a large district general hospital covering a clearly defined and relatively static population. All diabetic inpatients with foot problems were identified and followed-up until discharge or death. The demographic and admission details, medical history, investigation, procedure, and history and etiology of the loot lesion were collected twice weekly by a specialist nurse and podiatrist front all relevant wards. Thus, all subjects who underwent amputation could be identified. For comparison, retrospective data were collected from the hospital coding activities database, operating theater log hooks, anesthetic database, and limb-filling records.RESULTS - The total population of the region in 2000 was 337,859, of which 9,183 were known to have diabetes. The total number of amputations during the 3-year survey period was 79, of which 45 were major -,and 34 minor. In our local population, the mean incidence during the survey period (1997-2000) cquates to 7.8/100,000 general population and 2.85/1,000 diabetic population for all amputations, 4.5/100,000 general population and 1.62/1 000 diabetic population for major amputations, and 3.3/100,000 general population and 1.23/1,000 diabetic population for minor amputations. The prospective survey detected all lower-extremity amputations Identified by the various retrospective methods, however, for the reverse, this was not the case. All of the retrospective methods, including the most commonly used (ICD-9 and OPCS-4 coding), failed to detect all of the cases revealed by the prospective survey (error rate ranging from 4.2 to 90.6%), and between 4.5 and 17.49/o of amputation were misclassified.CONCLUSIONS - This study demonstrates the advantages of prospective data collection as a means of determining the incidence of lower-extrernity amputations and highlights the limitations of retrospective data collection methods, which underestimate the incidence. In particular, the operating theater records, which have been the gold standard for many surveys, were found to be unreliable. Moreover, we have shown a 47% reduction in the major amputations during the survey period. Thus, we recommend that a prospective audit be incorporated into the activities of the specialist foot care team as a means of assessing and improving clinical care.