Repeatability, completion time, and predictive ability of four diabetes-related foot ulcer classification systems

Alahakoon, Chanika, Fernando, Malindu, Galappaththy, Charith, Lazzarini, Peter, Moxon, Joseph V., Jones, Rhondda, and Golledge, Jonathan (2023) Repeatability, completion time, and predictive ability of four diabetes-related foot ulcer classification systems. Journal of Diabetes Science and Technology, 17 (1). pp. 35-41.

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Introduction: The inter and intra-observer reproducibility of measuring the Wound Ischemia foot Infection (WIfI) score is unknown. The aims of this study were to compare the reproducibility, completion times and ability to predict 30-day amputation of the WIfI, University of Texas Wound Classification System (UTWCS), Site, Ischemia, Neuropathy, Bacterial Infection and Depth (SINBAD) and Wagner classifications systems using photographs of diabetes-related foot ulcers.

Methods: Three trained observers independently scored the diabetes-related foot ulcers of 45 participants on two separate occasions using photographs. The inter- and intra-observer reproducibility were calculated using Krippendorff's α. The completion times were compared with Kruskal-Wallis and Dunn's post-hoc tests. The ability of the scores to predict 30-day amputation rates were assessed using receiver operator characteristic curves and area under the curves.

Results: There was excellent intra-observer agreement (α >0.900) and substantial agreement between observers (α=0.788) in WIfI scoring. There was moderate, substantial, or excellent agreement within the three observers (α>0.599 in all instances except one) and fair or moderate agreement between observers (α of UTWCS=0.306, α of SINBAD=0.516, α of Wagner=0.374) for the other three classification systems. The WIfI score took significantly longer (P<.001) to complete compared to the other three scores (medians and inter quartile ranges of the WIfI, UTWCS, SINBAD, and Wagner being 1.00 [0.88-1.00], 0.75 [0.50-0.75], 0.50 [0.50-0.50], and 0.25 [0.25-0.50] minutes). None of the classifications were predictive of 30-day amputation (P>.05 in all instances).

Conclusion: The WIfI score can be completed with substantial agreement between trained observers but was not predictive of 30-day amputation.

Item ID: 67070
Item Type: Article (Research - C1)
ISSN: 1932-2968
Keywords: diabetes-related foot ulcers; diabetic foot; prediction of amputation; reproducibility; telemedicine
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Copyright Information: © 2021 Diabetes Technology Society
Funders: Townsville and Hospital Health Services (SERTA), James Cook University (JCU), Queensland Government, National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC 1117061
Date Deposited: 17 Jun 2021 02:10
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320199 Cardiovascular medicine and haematology not elsewhere classified @ 100%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 100%
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