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Scottish Foot Ulcer Risk Score Predicts Foot Ulcer Healing in a Regional Specialist Foot Clinic

Ninewells Hospital, Dundee, DD1 9SY¹
Dundee Community Health Partnership², Westgate Health Centre, Dundee
University of Dundee, Ninewells Hospital and Medical School³
Surgery Ninewells Hospital Dundee⁴

graham.leese{at}tuht.scot.nhs.uk

ABSTRACT

AIMS: Have patients developing ulcers previously been identified as being at high risk of ulceration using the SCI-DC Ulcer Risk score. Does the risk score predicts ulcer healing.

METHODS: All patients attending the diabetes foot clinic with an ulcer had been assessed for foot ulcer risk using the SCI-DC risk calculator, which categorises patients into low, moderate or high-risk of ulceration. Information on foot pulses, neuropathy, foot deformity, previous ulcer, ulcer site, depth, and presence of sepsis was recorded, and related to ulcer outcome. Patients were followed up until outcome was achieved (median 3 months (range1-33months)).

RESULTS: Of patients attending the clinic with a foot ulcer (mean age 67.3 ±12.7 (SD) years, 68% male), 68% were previously recognised to be at high-risk of foot ulceration, and 98% were high or moderate-risk. Of 221 ulcers, the healing rate was 75% overall, but was lower for high-risk patients compared to other patients (68% vs 93%; p<0.0001). Of the remainder, 3% became chronic ulcers, 12% required minor or major amputation and 10% died with their ulcer. In multivariate analysis, absent pulses, neuropathy, increased age and deep ulcers were associated with poor healing. The combination of neuropathy and ischaemia was particularly associated with poor outcome of an ulcer (61% healing).

CONCLUSION: The Scottish foot ulcer risk score predicts both ulcer development and ulcer healing. The risk score can be a useful initial guide to likely poor healing. The individual criteria contributing to this overall risk are similar to other studies.

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