Leese Graham, Schofield Christopher, McMurray Brian, Libby Gillian, Golden Judith, MacAlpine Ritchie, Cunningham Scott, Morris Andrew, Flett Murray, Griffiths Gareth
Ward 1 and 2 Ninewells Hospital, Dundee, U.K. DD1 9SY.
Diabetes Care. 2007 Aug;30(8):2064-9. doi: 10.2337/dc07-0553. Epub 2007 May 22.
To determine whether patients developing ulcers had previously been identified as being at high risk of ulceration using the Scottish Care Information-Diabetes Collaboration (SCI-DC) ulcer risk score and whether the risk score predicts ulcer healing.
All patients attending the diabetes foot clinic with an ulcer had been assessed for foot ulcer risk using the SCI-DC risk calculator, which categorizes patients into low, moderate, or high risk of ulceration. Information on foot pulses, neuropathy, foot deformity, previous ulcer, ulcer site, depth, and presence of sepsis was recorded and related to ulcer outcome. Patients were followed up until outcome was achieved (median 3 months [range 1-33]).
Of patients attending the clinic with a foot ulcer (mean [+/-SD] age 67.3 +/- 12.7 years, 68% male), 68% were previously recognized to be at high risk of foot ulceration, and 98% were high or moderate risk. Of 221 ulcers, the healing rate was 75% overall but was lower for high-risk patients compared with other patients (68 vs. 93%; P < 0.0001). Of the remainder, 3% became chronic ulcers, 12% required minor or major amputation, and 10% died with their ulcer. In multivariate analysis, absent pulses, neuropathy, increased age, and deep ulcers were associated with poor healing. The combination of neuropathy and ischemia was particularly associated with poor outcome of an ulcer (61% healing).
The Scottish foot ulcer risk score predicts both ulcer development and ulcer healing. The risk score can be a useful initial guide to determine the likelihood of poor healing. The individual criteria contributing to this overall risk are similar to other studies.
确定发生溃疡的患者此前是否通过苏格兰医疗信息 - 糖尿病协作组织（SCI - DC）溃疡风险评分被认定为溃疡发生的高风险人群，以及该风险评分能否预测溃疡愈合情况。
所有前往糖尿病足门诊就诊且患有溃疡的患者均使用SCI - DC风险计算器进行了足部溃疡风险评估，该计算器将患者分为溃疡发生低、中、高风险类别。记录了足部脉搏、神经病变、足部畸形、既往溃疡、溃疡部位、深度及败血症情况等信息，并将其与溃疡结局相关联。对患者进行随访直至获得结局（中位时间3个月[范围1 - 33个月]）。
在前往门诊就诊的足部溃疡患者中（平均[±标准差]年龄67.3±12.7岁，68%为男性），68%此前被认定为足部溃疡高风险人群，98%为高风险或中风险人群。在221处溃疡中，总体愈合率为75%，但高风险患者的愈合率低于其他患者（68%对93%；P<0.0001）。其余患者中，3%发展为慢性溃疡，12%需要进行小截肢或大截肢，10%因溃疡死亡。在多变量分析中，脉搏缺失、神经病变、年龄增加及深部溃疡与愈合不良相关。神经病变和缺血的组合尤其与溃疡预后不良相关（愈合率61%）。
苏格兰足部溃疡风险评分可预测溃疡的发生及愈合情况。该风险评分可为确定愈合不良可能性提供有用的初步指导。构成这一总体风险的个体标准与其他研究相似。
