New scoring system for diabetic foot ulcers

ABSTRACT

To review the management and outcome of diabetic foot ulcers based on a novel scoring system for ulcers depending on the Phase of the ulcer [P], Extent of the ulcer [E], Degree of infection [D], Associated problems [A]. This scoring system is called PEDA score. Design: A prospective study. Setting: Jordan University Hospital The database of 80 diabetic patients seen at Jordan University Hospital with foot lesions between September 97 to April 2000 were studied prospectively. Data for gender, age, nature of foot lesions, presence of peripheral vascular disease, peripheral neuropathy, associated bone deformity, types of surgical procedure, morbidity and mortality were reviewed. Eighty patients with foot infections were seen at the hospital during the period from Sept 97 to April 2000. Patients were followed up from 1 month to 30 months. Mean age of the patients was 55 years ranging between 17-90 years. They were 50 males [62.5%] and 30 females [37.5%] Peripheral neuropathy was documented in 52 patients [65%]. Distal pulses were not present in 18 patients [22.5%]. Twenty four patients with superficial cellulitis without ulcers were excluded from the study. Twenty two patients [39%] had Low grade ulcers [PEDA score <6] all had complete healing of their original ulcers in 4-6 weeks, twenty patients [36%] had moderate grade ulcers [PEDA score7-9], sixteen patients from this group had complete healing in 6-12 weeks. Fourteen patient [25%] had high-grade ulcers [PEDA score 10-12], two patients had ulcers in association with Charcot joints, and another two with hallux valgus deformity. Local bone excision was performed on these patients and all had good results. Ten patients had significant peripheral vascular disease, one patient had a successful reconstruction, and the remainder required amputation at different levels. Patients with high-grade ulcers required in hospital management in excess of 12 weeks. Diabetic foot ulcers inflect a huge cost to society and disrupt the quality of life. We have developed a new scoring system [FED A] that allows categorization of diabetic foot ulcers into three groups depending on severity; low, moderate and high grade ulcers. The goal of this system is to optimize local ulcer care, provide an idea about the place, duration and the outcome of management. According to this score 75% of diabetic foot ulcers will fit the low and moderate grade ulcers with 90% success rate of ulcer healing in 2-3 months