Diabetic neuropathic foot ulcers: Predicting which ones will not heal
Diabetic neuropathic foot ulcers: Predicting which ones will not heal
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DOI：
10.1016/j.amjmed.2003.06.006
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发表时间：
2003-12-01
影响因子：
5.9
通讯作者：
Berlin, JA
中科院分区：
文献类型：
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作者：
Margolis, DJ;Allen-Taylor, L;Berlin, JA
目的：神经性足部溃疡是糖尿病的严重并发症。这项研究的目的是开发一种临床上有用的预后模型，用于识别不太可能愈合的溃疡。方法：使用大型伤口护理系统的管理和医疗记录数据库，我们设计了一项针对糖尿病神经性足部溃疡患者的队列研究。临床医生遵循良好的伤口护理、伤口清创和伤口卸载的标准算法。结果是经过20周的护理，伤口愈合了。对于有多个伤口的患者，我们调查标记为原发伤口的伤口。我们评估了几种不同数学复杂性的预测模型。结果：我们研究了27,630名糖尿病神经性足部溃疡患者，其中12,983人(47%)在20周的护理后痊愈。如果伤口大于2个月，大于2厘米(2)，或者等级大于或等于3(按6分制)，最简单的模型计算每个1分。在验证数据集中，伤口不愈合的可能性为0.35(计数为0)、0.47(计数为1)、0.66(计数为2)和0.81(计数为3)。结论：使用伤口护理检查中已有的预后因素，可以建立一个简单的预后模型。该模型的应用可以包括确定谁将在标准护理方面做得很好，并作为临床试验设计的辅助工具。(C)2003年，由Excerpta Medica Inc.
PURPOSE: Neuropathic foot ulcers are a serious complication of diabetes. The purpose of this study was to develop a clinically useful prognostic model for identifying ulcers that are not likely to heal.METHODS: Using an administrative and medical records database from a large wound care system, we designed a cohort study of patients with diabetic neuropathic foot ulcer. Clinicians followed a standard algorithm of good wound care, wound debridement, and wound offloading. The outcome was a healed wound by week 20 of care. For patients with more than one wound, we investigate the wound labeled as the primary wound. We evaluated several prognostic models of varying mathematical complexity.RESULTS: We studied 27,630 patients with a diabetic neuropathic foot ulcer, of whom 12,983 (47%) healed by week 20 of care. The simplest model counted 1 point each if the wound was older than 2 months, larger than 2 cm(2), or had a grade greater than or equal to3 (on a 6-point scale). The likelihood that a wound would not heal was 0.35 for a count of 0, 0.47 for a count of 1, 0.66 for a count of 2, and 0.81 for a count of 3 in the validation data set.CONCLUSION: A simple prognostic model can be developed using prognostic factors that are already part of the wound care examination. Applications of this model could include determining who will do well with standard care and as an aid in the design of clinical trials. (C)2003 by Excerpta Medica Inc.