Background: The management of diabetic foot ulcer (DFU) is a complex clinical problem requiring a multidisciplinary approach with the goal to reduce amputation risk and facilitate healing. The ADS recommends regular data collection on the incidence and outcomes of DFU (1).
Aim: To identify the clinical outcomes of the adult patients admitted to Eastern health hospitals with DFU and analyse their association with clinical factors including multidisciplinary care.
Methods: In this retrospective clinical audit, detailed information was obtained from medical records regarding baseline characteristics, management and clinical outcomes in patients with DFU requiring hospital admission between January 2013 and June 2014. We analysed the association between the clinical factors and the outcomes of DFUs.
Results: There were 174 admissions for DFU and the outcomes of 135 DFUs from 126 patients were identified. Among these 126 patients, 88% had type 2 diabetes, the mean age was 66.0 ± 12.8 years, mean diabetes duration 19.9 ± 10.8 years (n=119) and mean HbA1c 8.7 ± 2.0% (n=91).Wound severity at admission (Texan Grading System) (2): 96.3% DFUs were infected, 51.1% were ischaemic and 48.1% were infected and ischaemic. 65.9% of the DFUs penetrated to bone and 34.1% were superficial.
Lower limb amputation rate was 53.3%, healing rate 37% and chronic ulceration rate 9.7%. The significant predictors of amputation included wound penetrating to bone, peripheral vascular disease (PVD), previous amputation and lack of endocrinology involvement in management (Table 1). The significant predictors of DFU healing included superficial wound, absence of PVD, endocrinology involvement and multidisciplinary involvement in management (Table 2).
Conclusion: Apart from the well defined predictors of DFU outcome such as PVD (3), endocrinology involvement in the management of DFU significantly reduced amputation risk and facilitated the healing of DFU. Multidisciplinary care also played a significant role in the healing of DFUs.