Comparison of two classification systems in predicting the outcome of diabetic foot ulcers: the Wagner grade and the Saint Elian Wound score systems.

The aim of the study was to compare two systems of classification in a consecutive population with diabetic foot ulcers: the Wagner grade and the Saint Elian Wound Score System (SEWSS). Sociodemographic information, patient-related and ulcer-related data at first presentation was recorded, and the patients were followed up until wound healing or accepting major amputation or for 24 weeks. One hundred eighty-six patients were included in the study, of which 172 patients were completely followed up. Among the remaining 172 patients, 53.5% (n = 92) were healed without minor amputation, 32% (n = 55) were healed with minor amputation, 9.3% (n = 16) were not healed at study termination, 3.5% (n = 6) died and 1.7% (n = 3) underwent major amputation. The median healing time for Wagner 1, Wagner 2, Wagner 3, and Wagner 4 were 23, 50, 54, 119 days, respectively. The log-rank test showed significant differences in healing time for Wagner 1, Wagner 2, Wagner 3, and Wagner 4; The median healing time for SEWSS I, SEWSS II and SEWSS III were 12, 51, and 150 days, respectively. The log-rank test showed significant differences in healing time for SEWSS I, SEWSS II and SEWSS III. Cox regression analysis showed a decreasing probability of healing with or without minor amputation with a higher SEWSS value, an increase in the SEWSS by one score reduced the probability for healing by 24%. ROC analysis showed Wagner 3 and a cut-point 17 of SEWSS had the highest Youden's index. Both the Wagner grade and SEWSS system were associated with the ulcer healing time for the patients with active DFUs. The SEWSS score makes it a better prediction tool of DFU outcome synthetically.