Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Diabet Med. 2014 May;31(5):624-9. doi: 10.1111/dme.12388. Epub 2014 Jan 17.
To assess pre-hospital patient delay and its associated variables in patients with diabetic foot problems.
We classified 270 patients with diabetic foot problems retrospectively based on the distribution of pre-hospital delay. Clinical, demographic and socio-economic data were collected. Logistic regression analysis was performed to examine independent associations with patient delay.
The median pre-hospital delay time was 46.49 days. Patients reported short (≤ 1 week; 77 patients, 28.5%), moderate (> 1 week and ≤ 1 month; 106 patients, 39.3%) and long delays (> 1 month; 87 patients, 32.2%). In a univariate analysis, nine variables were associated with a longer delay (P < 0.05): (1) no previous ulcer; (2) no health insurance; (3) poor housing conditions; (4) low income level; (5) low educational level; (6) infrequent foot inspection; (7) few follow-up medical visits; (8) absence of diabetic foot education; (9) lack of knowledge of foot lesion warning signals. A multivariate analysis showed that absence of diabetic foot education (odds ratio 2.70, 95% CI 1.03-7.06, P = 0.043) and lack of knowledge of foot lesion warning signals (odds ratio 2.14, 95% CI 1.16-3.94, P = 0.015) were independent predictors of long patient delay. Long delay increased the risk of amputation (odds ratio 2.22, 95% CI 1.36-3.64, P = 0.002) and mortality (odds ratio 2.69, 95% CI 1.35-5.33, P = 0.005).
A number of factors were involved in pre-hospital delay among patients with diabetic foot problems and contributed to poor outcomes. We recommend developing a community intervention programme that targets at-risk communities to encourage earlier multidisciplinary team assessment to reduce disparities and improve foot outcomes in patients with diabetes.
评估糖尿病足患者的院前患者延迟及其相关变量。
我们根据院前延迟分布将 270 例糖尿病足患者回顾性分类。收集临床、人口统计学和社会经济数据。进行逻辑回归分析以检查与患者延迟相关的独立关联。
中位院前延迟时间为 46.49 天。患者报告了短（≤1 周；77 例，28.5%）、中（>1 周和≤1 个月；106 例，39.3%）和长延迟（>1 个月；87 例，32.2%）。在单因素分析中，有九个变量与较长的延迟相关（P<0.05）：（1）无既往溃疡；（2）无健康保险；（3）住房条件差；（4）收入水平低；（5）教育水平低；（6）足部检查不频繁；（7）随访医疗就诊次数少；（8）缺乏糖尿病足教育；（9）缺乏足部病变预警信号知识。多因素分析显示，缺乏糖尿病足教育（比值比 2.70，95%可信区间 1.03-7.06，P=0.043）和缺乏足部病变预警信号知识（比值比 2.14，95%可信区间 1.16-3.94，P=0.015）是患者延迟的独立预测因素。长时间的延迟增加了截肢（比值比 2.22，95%可信区间 1.36-3.64，P=0.002）和死亡（比值比 2.69，95%可信区间 1.35-5.33，P=0.005）的风险。
糖尿病足患者的院前延迟涉及多个因素，并导致不良结局。我们建议制定社区干预计划，针对高危社区，鼓励尽早进行多学科团队评估，以减少差异并改善糖尿病患者的足部结局。
