Allen Latricia, Powell-Cope Gail, Mbah Alfred, Bulat Tatjana, Njoh Eni
James A. Haley Veterans' Hospital, Tampa, FL.
Ostomy Wound Manage. 2017 Jun;63(6):30-33.
The risk of adverse events (AEs) such as infection and amputation related to diabetic foot ulcers (DFUs) has been studied, but less is known about rate of other AEs such as falls. As part of a quality improvement project, AEs in veterans with diabetes mellitus (DM) with and without a DFU were examined. Demographic data including ICD-9 codes, AEs, and comorbidities for all patients with a diagnosis of DM and/or DFU treated between 2009 and 2014 at the James A. Haley Veterans' Hospital, Tampa, FL, were reviewed retrospectively utilizing the Corporate Data Warehouse (CDW) database. Identifiable protected health information data using patient scrambled social security numbers were collected from the CDW to allow the longitudinal data to be linked at the unique patient level. Descriptive statistics (eg, mean, standard deviation) were determined for demographics, AE, and comorbidities. Adjusted models of AE association with DM and DFU were analyzed using regression modeling via a statistical analysis system. The models were adjusted for age, race, gender, marital status, and comorbidities. Data extracted included individuals diagnosed with diabetes with a DFU (n = 3238, average age 66.0 ± 10.6 years) and diabetes without DFU (n= 41 324, average age 64.4 ± 11.5 years). Participants were mostly Caucasian in both the DFU and non-DFU cohorts (2655 [82.0%] and 32 269 [78.1%], respectively) and male (3129 [96.6%] and 39 580 [95.8%], respectively). The most common comorbidities in this population were peripheral vascular disease (PVD, 39.5%) and peripheral neuropathy (PN, 23.2%). PVD was more common in veterans with (39.5%) than without a DFU (9.2%). Compared to individuals with DM, those with DM and DFU were significantly more likely to experience an infection (OR = 9.43; 95% CI 8.54-10.4), undergo an amputation (OR = 7.40; 95% CI 6.16-8.89), or experience a fracture (OR = 3.65; 95% CI 2.59-5.15) or fall (OR = 2.26; 95% CI 1.96-2.60) (P <.01 for all variables). Although the increased risk of infection and amputation among persons with DFUs has been documented, less is known about the rate of falls and fractures. The current findings will serve as baseline data for future implementation trials to reduce DFU-associated AEs, and clinicians may want to consider expanding DFU patient education efforts to include fall risk.
与糖尿病足溃疡（DFU）相关的不良事件（AE）如感染和截肢的风险已得到研究，但对于其他不良事件如跌倒的发生率了解较少。作为质量改进项目的一部分，对患有和未患有DFU的糖尿病（DM）退伍军人的不良事件进行了检查。回顾性分析了2009年至2014年在佛罗里达州坦帕市詹姆斯·A·黑利退伍军人医院接受治疗的所有诊断为DM和/或DFU患者的人口统计学数据，包括ICD - 9编码、不良事件和合并症，数据来自企业数据仓库（CDW）数据库。使用患者打乱的社会安全号码从CDW收集可识别的受保护健康信息数据，以便在唯一患者层面链接纵向数据。确定了人口统计学、不良事件和合并症的描述性统计量（如均值、标准差）。通过统计分析系统使用回归模型分析不良事件与DM和DFU关联的校正模型。模型对年龄、种族、性别、婚姻状况和合并症进行了校正。提取的数据包括诊断为患有DFU的糖尿病患者（n = 3238，平均年龄66.0±10.6岁）和未患有DFU的糖尿病患者（n = 41324，平均年龄64.4±11.5岁）。DFU组和非DFU组的参与者大多为白种人（分别为2655人[82.0%]和32269人[78.1%]）且为男性（分别为3129人[96.6%]和39580人[95.8%]）。该人群中最常见的合并症是外周血管疾病（PVD，39.5%）和外周神经病变（PN，23.2%）。PVD在患有DFU的退伍军人中（39.5%）比未患有DFU的退伍军人中（9.2%）更常见。与患有DM的个体相比，患有DM和DFU的个体更有可能发生感染（OR = 9.43；95%CI 8.54 - 10.4）、接受截肢（OR = 7.40；95%CI 6.16 - 8.89）、发生骨折（OR = 3.65；95%CI 2.59 - 5.15）或跌倒（OR = 2.26；95%CI 1.96 - 2.60）（所有变量P <.01）。虽然已记录DFU患者中感染和截肢风险增加，但对于跌倒和骨折的发生率了解较少。当前研究结果将作为未来减少DFU相关不良事件实施试验的基线数据，临床医生可能希望考虑扩大DFU患者教育工作，将跌倒风险纳入其中。
