糖尿病足溃疡管理的快速多学科方法：糖尿病快速评估与下肢截肢管理（DREAM）诊所。
Fast-Access Multidisciplinary Approach to Management of Diabetic Foot Ulcers: The Diabetic Rapid Evaluation and Lower Limb Amputation Management (DREAM) Clinic.
作者信息
Tang Fengjie, Abdul Razak Siti Nurfarahdillah Binte, Tan Jerilyn Xiling, Choke Edward Tieng Chek, Zainudin Sueziani Binte
机构信息
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Podiatry, Sengkang General Hospital, Singapore.
出版信息
Clin Med Insights Endocrinol Diabetes. 2023 Sep 29;16:11795514231196464. doi: 10.1177/11795514231196464. eCollection 2023.
BACKGROUND
Diabetic foot ulcers (DFUs) are debilitating to the patient and costly for the healthcare system. We set up the Diabetic Rapid Evaluation and lower limb Amputation Management (DREAM) clinic with the aim of providing early directed specialist care to patients with DFUs. With early management, we hope to treat DFUs in its early stages, reducing the need for and associated morbidity of major and minor lower limb amputations.
OBJECTIVES
We evaluated the outcomes of the fast-access DREAM clinic with multi-disciplinary evaluation for patients with DFUs. Outcomes include time from the point of referral to DREAM clinic evaluation, amputation rates and wound healing rates.
DESIGN
Patients presenting with DFU to the DREAM clinic were enrolled. A podiatrist made the first assessment, followed by immediate specialist consultation with Endocrinologists, Vascular surgeons or Orthopaedic surgeons as required.
METHODS
Data on baseline demographics and DFU characteristics were collected. Outcomes evaluated were wound healing at 12 weeks, wound salvage rates, time to DREAM clinic access and time to specialist referral.
RESULTS
Sixty-eight patients were enrolled, with 57.3% males, and mean age of 63 ± 13.0 years. Majority of ulcers were classified as neuropathic (41.3%) and located at the digits (40%). At 12-weeks follow-up, 1 had undergone major amputation, 9 minor amputations and 4 surgical debridements. The median time to DREAM clinic evaluation from first presentation was 3 days (IQR 7). Eleven (16.2%) required >1 specialist consult. Twenty (29.4%) were hospitalised for treatment. Twelve underwent revascularisation within 4 days (IQR 3.5). Twenty-four patients (35.3%) continued podiatry follow-up, having 28 DFUs in which 20 (71.4%) healed within 12 weeks.
CONCLUSION
The fast-access multidisciplinary DREAM clinic shows promising outcomes with lower major amputation rates and exemplary DFU healing outcomes.
背景
糖尿病足溃疡（DFUs）会使患者身体衰弱，且给医疗系统带来高昂成本。我们设立了糖尿病快速评估与下肢截肢管理（DREAM）诊所，旨在为糖尿病足溃疡患者提供早期定向专科护理。通过早期管理，我们希望在糖尿病足溃疡的早期阶段进行治疗，减少大、小下肢截肢的需求及相关发病率。
目的
我们评估了为糖尿病足溃疡患者提供多学科评估的快速就诊DREAM诊所的治疗效果。评估结果包括从转诊到DREAM诊所评估的时间、截肢率和伤口愈合率。
设计
纳入到DREAM诊所就诊的糖尿病足溃疡患者。由一名足病医生进行首次评估，随后根据需要立即与内分泌科医生、血管外科医生或骨科医生进行专科会诊。
方法
收集基线人口统计学数据和糖尿病足溃疡特征数据。评估的结果包括12周时的伤口愈合情况、伤口挽救率、到DREAM诊所就诊的时间以及到专科转诊的时间。
结果
共纳入68例患者，其中男性占57.3%，平均年龄为63±13.0岁。大多数溃疡被分类为神经性溃疡（41.3%），且位于脚趾（40%）。在12周的随访中，1例患者接受了大截肢，9例接受了小截肢，4例接受了外科清创术。从首次就诊到DREAM诊所评估的中位时间为3天（四分位间距为7）。11例（16.2%）患者需要不止一次专科会诊。20例（29.4%）患者住院治疗。12例患者在4天内（四分位间距为3.5）接受了血管重建术。24例患者（35.3%）继续接受足病随访，共有28处糖尿病足溃疡，其中20处（71.4%）在12周内愈合。
结论
快速就诊的多学科DREAM诊所显示出了良好的治疗效果，大截肢率较低，糖尿病足溃疡愈合效果堪称典范。
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