Golinko Michael S, Margolis David J, Tal Adit, Hoffstad Ole, Boulton Andrew J M, Brem Harold
Department of Surgery, Division of Wound Healing and Regenerative Medicine, Helen & Martin Kimmel Wound Center, New York University School of Medicine, 301 East 17th Street, New York, NY 10003, USA.
Wound Repair Regen. 2009 Sep-Oct;17(5):657-65. doi: 10.1111/j.1524-475X.2009.00527.x.
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 nonamputees. 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.
我们的目标是创建一个实用的标准化数据库，用于记录糖尿病足溃疡患者护理过程中临床相关变量。从伤口电子病历（WEMR）中提取了年龄、基线实验室值和伤口面积等数值型临床变量。开发了一种编码系统，将叙述性数据、培养结果和病理报告转化为离散的、可量化的变量。利用从WEMR中提取的数据，一个糖尿病足溃疡专用数据库纳入了以下表格：（1）人口统计学、病史和基线实验室值；（2）血管检测数据；（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。该数据库包含易于导出进行分析的变量。对至少有两次就诊记录（如数据库中的两条记录）的146例患者进行了截肢情况研究。分析显示，19例（13%）患者在23条肢体上进行了32次截肢（9次大截肢和23次小截肢）。使用比例风险模型分析发现，随着WEMR中就诊次数和记录数的增加，截肢风险降低，风险比为0.87（0.78，1.00）。进一步分析显示，两组患者在年龄、性别、糖化血红蛋白百分比、胆固醇、白细胞计数或基线前白蛋白水平方面无显著差异，而截肢组患者的血红蛋白和白蛋白水平显著低于非截肢组（p<0.05）。基于手术室活检，59%的截肢患者患有组织学骨髓炎，而非截肢患者的这一比例为45%。总之，利用WEMR跟踪患者是一种可提高患者安全性和护理质量的工具，能让临床医生更轻松地识别不愈合伤口并进行干预。本报告描述了一种收集糖尿病足溃疡患者临床护理相关数据的方法，并可能使临床医生能够根据自身患者群体调整此类系统。
