Risk prediction models for diabetic foot ulcer development or amputation: a review of reviews
Abstract Background In adults with diabetes, diabetic foot ulcer (DFU) and amputation are common and associated with significant morbidity and mortality. Purpose Identify tools predicting risk of DFU or amputation that are prognostically accurate and clinically feasible. Methods We searched for syst...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-01-01
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| Series: | Journal of Foot and Ankle Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13047-023-00610-6 |
| _version_ | 1827356279463477248 |
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| author | Anjum S. Kaka Adrienne Landsteiner Kristine E. Ensrud Brittany Logan Catherine Sowerby Kristen Ullman Patrick Yoon Timothy J. Wilt Shahnaz Sultan |
| author_facet | Anjum S. Kaka Adrienne Landsteiner Kristine E. Ensrud Brittany Logan Catherine Sowerby Kristen Ullman Patrick Yoon Timothy J. Wilt Shahnaz Sultan |
| author_sort | Anjum S. Kaka |
| collection | DOAJ |
| description | Abstract Background In adults with diabetes, diabetic foot ulcer (DFU) and amputation are common and associated with significant morbidity and mortality. Purpose Identify tools predicting risk of DFU or amputation that are prognostically accurate and clinically feasible. Methods We searched for systematic reviews (SRs) of tools predicting DFU or amputation published in multiple databases from initiation to January, 2023. We assessed risk of bias (ROB) and provided a narrative review of reviews describing performance characteristics (calibration and discrimination) of prognostically accurate tools. For such tools, we additionally reviewed original studies to ascertain clinical applicability and usability (variables included, score calculation, and risk categorization). Results We identified 3 eligible SRs predicting DFU or amputation risk. Two recent SRs (2020 and 2021) were rated as moderate and low ROB respectively. Four risk prediction models – Boyko, Martins‐Mendes (simplified), Martins‐Mendes (original), and PODUS 2020 had good prognostic accuracy for predicting DFU or amputation over time horizons ranging from 1‐ to 5‐years. PODUS 2020 predicts absolute average risk (e.g., 6% risk of DFU at 2 years) and consists of 3‐binary variables with a simple, summative scoring (0–4) making it feasible for clinic use. The other 3 models categorize risk subjectively (e.g., high‐risk for DFU at 3 years), include 2–7 variables, and require a calculation device. No data exist to inform rescreening intervals. Furthermore, the effectiveness of targeted interventions in decreasing incidence of DFU or amputation in response to prediction scores is unknown. Conclusions In this review of reviews, we identified 4 prognostically accurate models that predict DFU or amputation in persons with diabetes. The PODUS 2020 model, predicting absolute average DFU risk at 2 years, has the most favorable prognostic accuracy and is clinically feasible. Rescreening intervals and effectiveness of intervention based on prediction score are uncertain. |
| first_indexed | 2024-03-08T04:57:31Z |
| format | Article |
| id | doaj.art-78d721a060454293866b12888762b030 |
| institution | Directory Open Access Journal |
| issn | 1757-1146 |
| language | English |
| last_indexed | 2024-03-08T04:57:31Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Foot and Ankle Research |
| spelling | doaj.art-78d721a060454293866b12888762b0302024-02-07T15:05:46ZengWileyJournal of Foot and Ankle Research1757-11462023-01-01161n/an/a10.1186/s13047-023-00610-6Risk prediction models for diabetic foot ulcer development or amputation: a review of reviewsAnjum S. Kaka0Adrienne Landsteiner1Kristine E. Ensrud2Brittany Logan3Catherine Sowerby4Kristen Ullman5Patrick Yoon6Timothy J. Wilt7Shahnaz Sultan8Section of Infectious DiseasesMinneapolis VA Affairs Health Care System1 Veterans Drive111F55417MinneapolisMNUSAEvidence Synthesis ProgramMinneapolis Veterans Affairs Health Care SystemMinneapolisMNUSADepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSASection of PodiatryMinneapolis VA Affairs Health Care SystemMinneapolisMNUSAEvidence Synthesis ProgramMinneapolis Veterans Affairs Health Care SystemMinneapolisMNUSAEvidence Synthesis ProgramMinneapolis Veterans Affairs Health Care SystemMinneapolisMNUSASection of OrthopedicsMinneapolis VA Affairs Health Care SystemMinneapolisMNUSAEvidence Synthesis ProgramMinneapolis Veterans Affairs Health Care SystemMinneapolisMNUSAEvidence Synthesis ProgramMinneapolis Veterans Affairs Health Care SystemMinneapolisMNUSAAbstract Background In adults with diabetes, diabetic foot ulcer (DFU) and amputation are common and associated with significant morbidity and mortality. Purpose Identify tools predicting risk of DFU or amputation that are prognostically accurate and clinically feasible. Methods We searched for systematic reviews (SRs) of tools predicting DFU or amputation published in multiple databases from initiation to January, 2023. We assessed risk of bias (ROB) and provided a narrative review of reviews describing performance characteristics (calibration and discrimination) of prognostically accurate tools. For such tools, we additionally reviewed original studies to ascertain clinical applicability and usability (variables included, score calculation, and risk categorization). Results We identified 3 eligible SRs predicting DFU or amputation risk. Two recent SRs (2020 and 2021) were rated as moderate and low ROB respectively. Four risk prediction models – Boyko, Martins‐Mendes (simplified), Martins‐Mendes (original), and PODUS 2020 had good prognostic accuracy for predicting DFU or amputation over time horizons ranging from 1‐ to 5‐years. PODUS 2020 predicts absolute average risk (e.g., 6% risk of DFU at 2 years) and consists of 3‐binary variables with a simple, summative scoring (0–4) making it feasible for clinic use. The other 3 models categorize risk subjectively (e.g., high‐risk for DFU at 3 years), include 2–7 variables, and require a calculation device. No data exist to inform rescreening intervals. Furthermore, the effectiveness of targeted interventions in decreasing incidence of DFU or amputation in response to prediction scores is unknown. Conclusions In this review of reviews, we identified 4 prognostically accurate models that predict DFU or amputation in persons with diabetes. The PODUS 2020 model, predicting absolute average DFU risk at 2 years, has the most favorable prognostic accuracy and is clinically feasible. Rescreening intervals and effectiveness of intervention based on prediction score are uncertain.https://doi.org/10.1186/s13047-023-00610-6Risk predictionPrognostic modelDiabetic foot ulcerAmputation |
| spellingShingle | Anjum S. Kaka Adrienne Landsteiner Kristine E. Ensrud Brittany Logan Catherine Sowerby Kristen Ullman Patrick Yoon Timothy J. Wilt Shahnaz Sultan Risk prediction models for diabetic foot ulcer development or amputation: a review of reviews Journal of Foot and Ankle Research Risk prediction Prognostic model Diabetic foot ulcer Amputation |
| title | Risk prediction models for diabetic foot ulcer development or amputation: a review of reviews |
| title_full | Risk prediction models for diabetic foot ulcer development or amputation: a review of reviews |
| title_fullStr | Risk prediction models for diabetic foot ulcer development or amputation: a review of reviews |
| title_full_unstemmed | Risk prediction models for diabetic foot ulcer development or amputation: a review of reviews |
| title_short | Risk prediction models for diabetic foot ulcer development or amputation: a review of reviews |
| title_sort | risk prediction models for diabetic foot ulcer development or amputation a review of reviews |
| topic | Risk prediction Prognostic model Diabetic foot ulcer Amputation |
| url | https://doi.org/10.1186/s13047-023-00610-6 |
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