Abstract：
BACKGROUND: Classification and scoring systems can help both clinical management and audit the outcomes of routine care.
OBJECTIVE: This study aimed to assess published systems used to characterise ulcers in people with diabetes to determine which should be recommended to (a) aid communication between health professionals, (b) predict clinical outcome of individual ulcers, (c) characterise people with infection and/or peripheral arterial disease, and (d) audit to compare outcomes in different populations. This systematic review is part of the process of developing the 2023 guidelines to classify foot ulcers from the International Working Group on Diabetic Foot.
METHODS: We searched PubMed, Scopus and Web of Science for articles published up to December 2021 which evaluated the association, accuracy or reliability of systems used to classify ulcers in people with diabetes. Published classifications had to have been validated in populations of >80% of people with diabetes and a foot ulcer.
RESULTS: We found 28 systems addressed in 149 studies. Overall, the certainty of the evidence for each classification was low or very low, with 19 (68%) of the classifications being assessed by ≤ 3 studies. The most frequently validated system was the one from Meggitt-Wagner, but the articles validating this system focused mainly on the association between the different grades and amputation. Clinical outcomes were not standardized but included ulcer-free survival, ulcer healing, hospitalisation, limb amputation, mortality, and cost.
CONCLUSIONS: Despite the limitations, this systematic review provided sufficient evidence to support recommendations on the use of six particular systems in specific clinical scenarios.
OBJECTIVE: This study aimed to assess published systems used to characterise ulcers in people with diabetes to determine which should be recommended to (a) aid communication between health professionals, (b) predict clinical outcome of individual ulcers, (c) characterise people with infection and/or peripheral arterial disease, and (d) audit to compare outcomes in different populations. This systematic review is part of the process of developing the 2023 guidelines to classify foot ulcers from the International Working Group on Diabetic Foot.
METHODS: We searched PubMed, Scopus and Web of Science for articles published up to December 2021 which evaluated the association, accuracy or reliability of systems used to classify ulcers in people with diabetes. Published classifications had to have been validated in populations of >80% of people with diabetes and a foot ulcer.
RESULTS: We found 28 systems addressed in 149 studies. Overall, the certainty of the evidence for each classification was low or very low, with 19 (68%) of the classifications being assessed by ≤ 3 studies. The most frequently validated system was the one from Meggitt-Wagner, but the articles validating this system focused mainly on the association between the different grades and amputation. Clinical outcomes were not standardized but included ulcer-free survival, ulcer healing, hospitalisation, limb amputation, mortality, and cost.
CONCLUSIONS: Despite the limitations, this systematic review provided sufficient evidence to support recommendations on the use of six particular systems in specific clinical scenarios.
摘要：
背景：分类和评分系统可以帮助临床管理和审核常规护理的结果。
目的：本研究旨在评估已发表的用于表征糖尿病患者溃疡的系统，以确定应推荐哪些系统（a）有助于卫生专业人员之间的沟通，（b）预测个别溃疡的临床结果，(c)描述感染和/或外周动脉疾病患者的特征，和(d)审计，以比较不同人群的结果。本系统评价是制定2023年糖尿病足国际工作组对足部溃疡进行分类的指南过程的一部分。
方法：我们搜索了PubMed，Scopus和WebofScience发表了截至2021年12月评估该协会的文章，用于对糖尿病患者溃疡进行分类的系统的准确性或可靠性。已发表的分类必须在>80％的糖尿病和足部溃疡患者中得到验证。
结果：我们在149项研究中发现了28个系统。总的来说,每种分类的证据的确定性很低或很低，其中19项（68%）分类由≤3项研究评估。最频繁验证的系统是Meggitt-Wagner的系统,但是验证该系统的文章主要集中在不同年级与截肢之间的关联。临床结果未标准化，但包括无溃疡生存期，溃疡愈合，住院治疗,截肢,死亡率,和成本。
结论：尽管存在局限性，本系统综述提供了足够的证据支持在特定临床场景中使用6种特定系统的建议.
目的：本研究旨在评估已发表的用于表征糖尿病患者溃疡的系统，以确定应推荐哪些系统（a）有助于卫生专业人员之间的沟通，（b）预测个别溃疡的临床结果，(c)描述感染和/或外周动脉疾病患者的特征，和(d)审计，以比较不同人群的结果。本系统评价是制定2023年糖尿病足国际工作组对足部溃疡进行分类的指南过程的一部分。
方法：我们搜索了PubMed，Scopus和WebofScience发表了截至2021年12月评估该协会的文章，用于对糖尿病患者溃疡进行分类的系统的准确性或可靠性。已发表的分类必须在>80％的糖尿病和足部溃疡患者中得到验证。
结果：我们在149项研究中发现了28个系统。总的来说,每种分类的证据的确定性很低或很低，其中19项（68%）分类由≤3项研究评估。最频繁验证的系统是Meggitt-Wagner的系统,但是验证该系统的文章主要集中在不同年级与截肢之间的关联。临床结果未标准化，但包括无溃疡生存期，溃疡愈合，住院治疗,截肢,死亡率,和成本。
结论：尽管存在局限性，本系统综述提供了足够的证据支持在特定临床场景中使用6种特定系统的建议.
