1. A New Wound-Based Severity Score for Diabetic Foot Ulcers : A prospective analysis of 1,000 patients
Beckert,  Maria Witte,  Corinna Wicke, 
Alfred Königsrainer,  Stephan Coerper 
Diabetes Care. May 2006.Vol.29
R1 문송미

2. Background

3. Diabetic foot Risk for foot ulcerations :15%
Recur risk : 70% of healed ulcers
within 5 yrs
Risk factor
1) Peripheral neuropathy
2) Peripheral vascular disease
3) Abnormal plantar pressure load
4) Infection

4. DM foot classification system
Meggit –Wagner classification

5. DM foot classification system
The University of Texas system

6. DM foot classification system
Classification system by Treece et al.

7. Object

8. To establish a new wound-based clinical scoring system for diabetic foot ulcers
To anticipate chances for healing and risk of amputation

9. Research and method

10. Research group December 1997 and April 2004 1,000 consecutive patients
DM pts.( the criteria of WHO )
Followed-up for 365 days or until healing or
amputation if earlier
Excluded less than two visits during the observation period

11. Diabetic foot ulcer scoring system
According to a severity
Score rang : O to 4
Parameters
1) Palpable pedal pulses
2) Probing to bone
3) Ulcer location (foot or toe ulcer)
4) The presence of multiple ulcers
The aim of scoring system
- Prediction of clinical outcome defined as
probability of healing and risk for amputation

12. Wounds Wound depth - Grade 1 : dermis - Grade 2 : subcutaneous
- Grade 3 : fascia
- Grade 4 : muscle
- Grade 5 : bone
Single or multiple ulcerations on the same foot
Healing : as complete epithelization

13. Amputation
- Minor : toe or forefoot amputation
- Major : below or above knee amputation
Soft tissue infection
- Purulent discharge
- Two other local signs
: warmth, erythema, edema, lymphangitis,
lymphadenopathy or pain

14. Local wound therapy Wound care - Sharp debridement
- Local surgical procedures : limited bone resections
- Moist wound therapy
- Pressure off loading

15. Diabetic ulcer severity score(DUSS)1
Pedal pulses
present
absent
Bone involvement
no probing to bone
probing to bone
Site of ulceration
toe
foot
Number of ulcerations
single
multiple

16. Result

17. Table1. Baseline dermographic details

18. Figure 1. Probability of healing according to the DUSS

19. Univariate analysis of parameters reducing chance for healing
1) Nonpalpable pedal pulses (P<0.0009)
2) Probing to bone (P<0.0019)
3) Multiple ulcerations (P< )
4) Foot ulceration(P< )
- Local soft tissue infection (P<0.5324)

20. Table2. Multivariate analysis of parameters reducing chance for healing

21. Table3. Subgroup analysis with respect to ulcer severity score

22. Discussion

23. Nylon monofilament test

24. Usual location of ulcer

25. The influencing factor of ulcer healing
Location of ulcer
Consequenent off loading
Recurrent soft tissue infection
Immediate and adequate therapy

26. The result of DUSS Increasing in the DUSS by one score point
 reduced the chance for healing by 35%
Adequate local surgery and minor amputation prevent major amputation

27. The using of DUSS
Easy diagnostic tool for anticipating probability of healing, hospital admission and local surgery
Daily clinical practice
Suitable easily applied in estimating putative health care costs
Not setting up the subsequent wound care according to DUSS

28. Conclusion

29. DUSS Wound based score Not investigation disease based parameters
Predicting clinical outcome
The communication index between health care providers