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Use of the SINBAD classification system and score in comparing outcome of foot ulcer management in three continents

¹Foot Ulcer Trials Unit, Diabetes and Endocrinology, City Hospital, Nottingham, NG5 1PB, UK
²Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania
³Abbas Medical Centre, Dar es Salaam, Tanzania
⁴Baqai Institute of Diabetology & Endocrinology, Baqai Medical University, Karachi, Pakistan
⁵Internal Medicine, Marienkrankenhaus gem.GmbH, Soest, Germany

wjeffcoate{at}futu.co.uk

ABSTRACT

Objective: To compare populations and outcomes of diabetic foot ulcers managed in UK, Germany, Tanzania and Pakistan, and to explore the use of a new score of ulcer type in comparing outcome between different countries

Research Design and Methods: Data from a series of 449 patients managed in UK were used to evaluate the new simplified system of classification, and to derive an aggregate score. The use of the score was then explored using data from series managed in Germany (239), Tanzania (479) and Pakistan (173).

Results: A highly significant difference was found in time to healing between ulcers of increasing score in the UK series (p=0.000, Kruskal Wallis). When data from all centers were examined, a step up in days to healing was noted for those with scores of 3 or more (out of 6). Examination of baseline variables contributing to outcome revealed differences between centers: ischemia, ulcer area and depth contributing to outcome in UK; ischemia, area, depth and infection in Germany; depth, infection and neuropathy in Tanzania and depth alone in Pakistan.

Conclusions: Any system of classification designed for general implementation must encompass all the variables which contribute to outcome in different communities. The adoption of a simple score based on these variables, the SINBAD score, may prove a useful tool to predict ulcer outcome and to enable comparison between different centers.

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