*Department of Infectious diseases, Hawthorn Medical Associates, Dartmouth, MA.
†Department of Anesthesiology, St. Elizabeth Hospital, Brighton, MA.
J Am Podiatr Med Assoc. 2022 Apr 27;112(2):19-175. doi: 10.7547/19-175.
Multiple organizations have issued guidelines to address the prevention, diagnosis, and management of diabetic foot ulcers (DFUs) based on evidence review and expert opinion. We reviewed these guidelines to identify consensus (or lack thereof) on the nature of these recommendations, the strength of the recommendations, and the level of evidence.
Ovid, PubMed, Web of Science, Cochrane Library, and Embase were searched in October 2018 using the MESH term diabetic foot, the key word diabetic foot, and the filters guideline or practice guideline. To minimize recommendations based on older literature, guidelines published before 2012 were excluded. Articles without recommendations characterized by strength of recommendation and level of evidence related specifically to DFU were also excluded. A manual search for societal recommendations yielded no further documents. Recommendations were ultimately extracted from 12 articles. Strength of evidence and strength of recommendation were noted for each guideline recommendation using the Grading of Recommendations Assessment, Development, and Evaluation system or the Centre for Evidence-Based Medicine system. To address disparate grading systems, we mapped the perceived level of evidence and strength of recommendations onto the American Heart Association guideline classification schema.
Recommendations found in two or more guidelines were collected into a clinical checklist characterized by strength of evidence and strength of recommendation. Areas for future research were identified among recommendations based on minimal evidence, areas of controversy, or areas of clinical care without recommendations.
Through this work we developed a multidisciplinary set of DFU guidelines stratified by strength of recommendation and quality of evidence, created a clinical checklist for busy practitioners, and identified areas for future focused research. This work should be of value to clinicians, guideline-issuing bodies, and researchers. We also formulated a method for the review and integration of guidelines issued by multiple professional bodies.
多个组织已根据循证审查和专家意见发布了有关糖尿病足溃疡（DFU）预防、诊断和管理的指南。我们审查了这些指南，以确定这些建议的性质、建议的强度以及证据水平方面是否存在共识（或缺乏共识）。
2018 年 10 月，我们使用 MESH 术语糖尿病足、关键词糖尿病足以及指南或实践指南过滤器，在 Ovid、PubMed、Web of Science、Cochrane Library 和 Embase 中进行了搜索。为了尽量减少基于旧文献的建议，排除了 2012 年以前发布的指南。还排除了没有具体针对 DFU 的推荐强度和证据水平特征的没有推荐的文章。针对社会建议进行的手动搜索没有产生其他文件。最终从 12 篇文章中提取了建议。使用推荐评估、制定和评估系统或循证医学中心系统为每个指南建议记录证据强度和推荐强度。为了解决不同的分级系统问题，我们将感知到的证据水平和推荐强度映射到美国心脏协会指南分类方案上。
在两个或更多指南中找到的建议被收集到一个具有证据强度和推荐强度的临床检查表中。根据证据不足、存在争议或缺乏建议的临床护理领域确定了未来的研究建议。
通过这项工作，我们根据推荐强度和证据质量制定了一套多学科的 DFU 指南，为忙碌的从业者创建了临床检查表，并确定了未来重点研究的领域。这项工作应该对临床医生、指南制定机构和研究人员有价值。我们还制定了一种方法，用于审查和整合多个专业机构发布的指南。
