The aim of this study is to describe the etiology and clinical outcome of 334 diabetics with lower extremity wounds that were evaluated and treated using standardized criteria. Patients with wounds were identified from a cohort of 1687 diabetic patients treated in a capitated managed care plan. The underlying etiology for wounds was identified as venous stasis, decubitus, neuropathic, neuro-ischemic, or traumatic. Sensory neuropathy was determined using a 10 gram Semmes-Weinstein monofilament and Biothesiometer (>25 volts). Peripheral Arterial Occlusive Disease (PAOD) was determined by evaluating peripheral pulses and bi-directional doppler studies. ABI’s <0.80 were considered abnormal. Patients with PAOD were immediately referred to a vascular surgeon for consultation and angiography as needed. Outcomes included time to healing, re-ulceration after healing, and proportion of patients from each group that required hospital admission, amputations, and death. Patient follow-up ranged from 7-20 months.
Results: The etiology of wounds identified in the study was 10.8% venous stasis, 5.1 % decubitus, 55.1% neuropathic, 29.0 % neuro-ischemic. The average time to healing was significantly longer for patients with underlying PAOD compared to other wound etiologies. Likewise, patients with PAOD required hospitalization more frequently (41.2% PAOD versus 13.0% neuropathic, 5.9% decubitus, 2.8% venous) and the average length of stay was significantly longer compared to patients without underlying PAOD (PAOD 18 days vs Neuropathic 5 days, Venous 3 days, Decubitus 3 days).
Learning Objectives: The aim of this study is to describe the etiology and clinical outcome of 334 diabetics with lower extremity wounds that were evaluated and treated using standardized criteria
Keywords: Diabetes, Minority Health
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.