Preliminary development of a diabetic foot ulcer database from a wound electronic medical record: a tool to decrease limb amputations.
Preliminary development of a diabetic foot ulcer database from a wound electronic medical record: a tool to decrease limb amputations.
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DOI：
10.1111/j.1524-475x.2009.00527.x
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发表时间：
2009-09
期刊：
影响因子：
--
通讯作者：
Brem H
中科院分区：
文献类型：
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作者：
Golinko MS;Margolis DJ;Tal A;Hoffstad O;Boulton AJ;Brem H
我们的目标是创建一个实用的标准化数据库，用于糖尿病和足部溃疡患者的护理中的临床相关变量。从伤口电子病历(WEMR)中提取诸如年龄、基线化验值和伤口面积等数值临床变量。开发了一种编码系统，将叙事数据、文化和病理报告转换为离散的、可量化的变量。使用从WEMR中提取的数据，糖尿病足溃疡特定数据库包含以下表格：(1)人口统计学、病史和基线实验室数值；(2)血管测试数据；(3)放射学数据；(4)伤口特征；(5)伤口清创数据，包括病理、培养结果和截肢数据。该数据库包含可轻松导出以进行分析的变量。截肢手术在146名患者中进行了研究，这些患者至少有两次就诊(例如，数据库中的两个条目)。分析显示，19例(13%)患者接受了23条肢体的32次截肢(9次大截肢，23次截肢)。使用比例风险模型，截肢风险降低0.87(0.78，1.00)，与西医急诊室就诊和入院次数增加相关。进一步分析发现，截肢者在年龄、性别、HbA1c%、胆固醇、白细胞计数或前白蛋白方面没有显著差异，而截肢者组的血红蛋白和白蛋白显著低于非截肢者组(p<；0.05)。59%的截肢者患有基于手术室活检的组织学骨髓炎，而非截肢者的这一比例为45%。总之，使用WEMR跟踪患者是一种潜在地提高患者安全性和护理质量的工具，使临床医生能够更容易地识别未愈合的伤口并进行干预。这份报告描述了一种获取与糖尿病足溃疡患者的临床护理相关的数据的方法，并可能使临床医生能够使这样的系统适应他们自己的患者群体。
Our objective was to create a practical standardized database of clinically relevant variables in the care of patients with diabetes and foot ulcers. Numerical clinical variables such as age, baseline laboratory values, and wound area were extracted from the wound electronic medical record (WEMR). A coding system was developed to translate narrative data, culture, and pathology reports into discrete, quantifiable variables. Using data extracted from the WEMR, a diabetic foot ulcer-specific database incorporated the following tables: (1) demographics, medical history, and baseline laboratory values; (2) vascular testing data; (3) radiology data; (4) wound characteristics; and (5) wound debridement data including pathology, culture results, and amputation data. The database contains variables that can be easily exported for analysis. Amputation was studied in 146 patients who had at least two visits (e.g., two entries in the database). Analysis revealed that 19 (13%) patients underwent 32 amputations (nine major and 23 minor) in 23 limbs. There was a decreased risk of amputation, 0.87 (0.78, 1.00), using a proportional hazards model, associated with an increased number of visits and entries in the WEMR. Further analysis revealed no significant difference in age, gender, HbA1c%, cholesterol, white blood cell count, or prealbumin at baseline, whereas hemoglobin and albumin were significantly lower in the amputee group (p < 0.05) than the nonamputee group. Fifty-nine percent of amputees had histological osteomyelitis based on operating room biopsy vs. 45% of non-amputees. In conclusion, tracking patients with a WEMR is a tool that could potentially increase patient safety and quality of care, allowing clinicians to more easily identify a nonhealing wound and intervene. This report describes a method of capturing data relevant to clinical care of a patient with a diabetic foot ulcer, and may enable clinicians to adapt such a system to their own patient population.