Even For the Non-Infected Wound: Mortality is Poor– Lessons from Nottingham

Lessons from Almelo’s Sjef Van Baal with William Jeffcoate and Fran Game of the Foot Ulcer Trials Unit in Nottingham- people with non-infected neuropathic wounds have an average life expectancy 14 years lower than their non-wounded counterparts.

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Diabetes Care. 2010 May;33(5):1086-9. Epub 2010 Feb 25.

Mortality associated with acute charcot foot and neuropathic foot ulceration.

van Baal J, Hubbard R, Game F, Jeffcoate W.

Foot Ulcer Trials Unit, Nottingham University Hospitals Trust, City Hospital Campus, Nottingham, UK.

Abstract

OBJECTIVE: To compare the mortality of patients with an acute Charcot foot with a matched population with uninfected neuropathic foot ulcers (NFUs). RESEARCH DESIGN AND METHODS: Data were extracted from a specialist departmental database, supplemented by hospital records. The findings were compared with the results of earlier populations with Charcot foot and uninfected NFUs managed from 1980. Finally, the results of all patients with acute Charcot foot and all control subjects managed between 1980 and 2007 were compared with normative mortality data for the U.K. population. RESULTS: A total of 70 patients presented with an acute Charcot foot (mean age 57.4 +/- 12.0 years; 48 male [68.6%]) between 2001 and 2007; there were 66 matched control subjects. By 1 October 2008, 13 (eight male; 18.6%) patients with a Charcot foot had died, after a median of 2.1 years (interquartile range 1.1-3.3). Twenty-two (20 male; 33.3%) control subjects had also died after a median of 1.3 years (0.6-2.5). There was no difference in survival between the two groups (log-rank P > 0.05). Median survival of all 117 patients with acute Charcot foot managed between 1980 and 2007 was 7.88 years (4.0-15.4) and was not significantly different from the control NFU patients (8.43 years [3.4-15.8]). When compared with normative U.K. population data, life expectancy in the two groups was reduced by 14.4 and 13.9 years, respectively. CONCLUSIONS: These data confirm that the mortality in patients presenting to our unit with either an acute Charcot foot and an uninfected neuropathic ulcer was unexpectedly high.

David G. Armstrong

Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.

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