Clinical Classification of the Diabetic Foot Syndrome Adapted to ICD-10 as a Solution to the Problem of Diagnostics, Statistics and Standardisation
Background and Objectives: To propose a new classification of diabetic foot syndrome adapted for inclusion in the ICD-10 (the ICD-10 is the 10th revision of the International Statistical Classification of Diseases) and providing more reliable data on the number of clinical cases. Materials and Methods: A randomized controlled trial was performed. A total of 180 patients (36.6%) discharged from the hospital after surgical treatment and 312 patients (63.4%) who applied independently were observed and analysed. All patients had type 2 diabetes and were comparable in gender, age, duration of diabetes, area and nature of the wound defect. Results: We proposed to add the following to the existing ICD-10 and the emerging ICD-11 codes: Edf10.0—insulin-dependent diabetes mellitus with diabetic foot syndrome and Edf11.0—non-insulin-dependent diabetes mellitus with diabetic foot syndrome, where “df” is an acronym for diabetic foot. The new classification designates the seven most frequent areas of the lesion and five degrees of depth of soft tissue lesions. Conclusions: The proposed classification adapted for ICD-10 will enable the standardisation of diagnosis, providing a complete picture of this complication of diabetes mellitus, determining the number of amputations and their validity. Accurate statistics will allow for objective funding and timely preventive measures.
1. Introduction
Diabetes mellitus is a serious threat to human health around the world [1,2,3]. Diabetes mellitus does not depend on social status, financial status or nationality. According to the latest data published in the Diabetes Atlas of the International Diabetes Federation (IDF) (ninth edition), 463 million adults around the world are now living with diabetes [4].
Diabetic foot syndrome combines pathological changes in the peripheral nervous system, arterial and microcirculatory bed and osteoarticular apparatus of the foot, which pose an immediate threat, or the development of ulcerative-necrotic processes and gangrene of the foot [5,6,7,8]. Diabetic foot syndrome occurs in 25% of diabetes mellitus cases, with 85% leading to amputation [9].
To predict and choose treatment approaches, many classifications of diabetic foot syndrome have been proposed, but all have certain drawbacks. Most classifications focus on the visual presentation of lesions in diabetic foot syndrome. For example, the Wagner classification estimates the depth of a trophic ulcer without concomitant lesions such as angiopathy and neuropathy [10]. The University of Texas staging system for diabetic foot ulcers [11], in addition to depth of lesion, assesses the degree of infection and severity of ischemia without considering neurological disorders. The depth of the wound, severity of the infectious process and state of the peripheral blood supply are assessed by the WIFI classification [12,13]….
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[Tratto da: www.ncbi.nlm.nih.gov ]
