New Scoring System Predicts Amputations

Congrats to Ben Lipsky and company for this outstanding work in this months' Diabetes Care. This synopsis courtesy of Healthday News.

A new scoring system that stratifies the risk of nontraumatic lower-extremity amputation (LEA) among patients hospitalized for a diabetic foot infection, has been developed and validated, according to a study published in the August issue of Diabetes Care.

Benjamin A. Lipsky, M.D., from the Veterans Administration Puget Sound Health Care System in Seattle, and colleagues developed a scoring system to identify patients who are at the highest risk for LEA. Data were collected from 3,018 patients hospitalized with culture-documented diabetic foot infections between 2003 and 2007 in 97 hospitals in the United States. Demographic data, clinical presentation, chronic diseases, and recent previous hospitalization were included as candidate risk factors for LEA. A logistic regression model was used to calculate a numeric risk score from 75 percent of the population, and the score was validated in the remaining 25 percent of patients.

The investigators found that 21.4 percent of the patients underwent an LEA. Surgical site infection, vasculopathy, previous LEA, and a white blood cell count >11,000 per mm³ were the risk factors most highly correlated with LEA. The predictive model had good discrimination (c-statistic, 0.76) and excellent calibration between predicted and observed LEA rates. Patients were stratified into five groups based on the risk score, exhibiting a significant graded relation to LEA risk. For patients with a score of 0, the LEA rates were 0 percent and for those with a score of ≥21, the LEA rates were approximately 50 percent.

“Using a large, hospitalized population, we developed and validated a risk score that seems to accurately stratify the risk of LEA among patients hospitalized for a diabetic foot infection. This score may help to identify high-risk patients upon admission,” the authors write.

Several authors disclosed financial ties with the pharmaceutical industry, including to Ortho-McNeil Janssen Scientific Affairs, which partially funded the study.

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