Diabetic Foot Unit, University of Tor Vergata, Rome, Italy.
Diabetic Foot Unit, University of Tor Vergata, Rome, Italy.
Diabetes Res Clin Pract. 2020 Jul;165:108245. doi: 10.1016/j.diabres.2020.108245. Epub 2020 Jun 1.
To define the outcomes of persons with diabetes and foot ulcers (DFUs) managed through a specific triage pathway during the COVID-19 crisis.
Patients who had an active DFU during the COVID-19 emergency were included. All participants were managed using a specific triage system driven both by ulcer'severity and concomitant co-diseases. Subjects with severely complicated DFUs were urgently referred to hospital regardless of the concomitant comorbidities. Subjects with complicated DFUs received outpatient evaluation (within 48-72 h) and were admitted to hospital if required (revascularization, surgical intervention, intravenous antibiotic therapy); after the first outpatient visit or hospitalization, patients were followed according to the number of comorbidities (in the case of 3 or more comorbidities patients were followed up by telemedicine). Patients with uncomplicated DFUs were managed by telemedicine after outpatient evaluation. Healing, major amputation, death and rate of COVID-19 infection were evaluated. The minimum follow-up was 1 month.
The study group included 151 patients. The mean age was 69.9 ± 14.2 years, 58.9% were male and 91.4% had type 2 diabetes; 58.7% had severely complicated, 21% complicated and 20.3% uncomplicated DFUs. Among those, 78.8% presented with 3 or more comorbidities. One hundred and six patients had regular clinical follow-ups, while 45 were managed through telemedicine. Forty-one (27.1%) patients healed, 3 (1.9%) had major amputations and 3 (1.9%) died. One patient (0.6%) reported COVID-19 positivity due to infection acquired at home.
The triage pathway adopted during the COVID-19 pandemic showed adequate management of DFUs and no cases of hospital virus exposure.
定义在 COVID-19 危机期间通过特定分诊途径管理的糖尿病合并足部溃疡（DFU）患者的结局。
纳入在 COVID-19 紧急情况下患有活动性 DFU 的患者。所有参与者均采用特定的分诊系统进行管理，该系统既考虑了溃疡的严重程度，也考虑了伴随的合并症。严重复杂 DFU 的患者无论合并症如何，均紧急转至医院。复杂 DFU 的患者在 48-72 小时内接受门诊评估，如果需要（血运重建、手术干预、静脉抗生素治疗）则住院；在首次门诊就诊或住院后，根据合并症的数量对患者进行随访（如果有 3 种或更多合并症，则通过远程医疗进行随访）。门诊评估后，简单 DFU 的患者通过远程医疗进行管理。评估愈合、大截肢、死亡和 COVID-19 感染率。随访时间至少 1 个月。
研究组纳入 151 例患者。平均年龄为 69.9±14.2 岁，58.9%为男性，91.4%患有 2 型糖尿病；58.7%为严重复杂，21%为复杂，20.3%为简单 DFU。其中，78.8%有 3 种或更多合并症。106 例患者有定期临床随访，45 例通过远程医疗进行管理。41 例（27.1%）患者愈合，3 例（1.9%）患者行大截肢，3 例（1.9%）患者死亡。1 例（0.6%）患者因在家中感染而报告 COVID-19 阳性。
在 COVID-19 大流行期间采用的分诊途径对 DFU 进行了充分的管理，且没有发生医院内病毒暴露的情况。
