METHODS: First, we have developed a list of classification systems considered as being potentially adequate for use in a clinical setting, through the summary of judgements for diagnostic tests, focussing on the usability, accuracy and reliability of each system to predict ulcer-related complications as well as use of resources. Second, we have determined, following group debate and consensus, which of them should be used in specific clinical scenarios. Following this process, in a person with diabetes and a foot ulcer we recommend: (a) for communication among healthcare professionals: to use the SINBAD (Site, Ischaemia, Bacterial infection, Area and Depth) system (first option) or consider using WIfI (Wound, Ischaemia, foot Infection) system (alternative option, when the required equipment and level of expertise is available and it is considered feasible) and in each case the individual variables that compose the systems should be described rather than a total score; (b) for predicting the outcome of an ulcer in a specific individual: no existing system could be recommended; (c) for characterising a person with an infected ulcer: the use of the IDSA/IWGDF classification (first option) or consider using the WIfI system (alternative option, when the required equipment and level of expertise is available and it is considered as feasible); (d) for characterising a person with peripheral artery disease: consider using the WIfI system as a means to stratify healing likelihood and amputation risk; (e) for the audit of outcome(s) of populations: the use of the SINBAD score.
CONCLUSIONS: For all recommendations made using GRADE, the certainty of evidence was judged, at best, as being low. Nevertheless, based on the rational application of current data this approach allowed the proposal of recommendations, which are likely to have clinical utility.
方法:首先,我们已经开发了一个分类系统列表,被认为是潜在的足够用于临床设置,通过诊断测试的判断摘要,专注于可用性,每个系统预测溃疡相关并发症的准确性和可靠性以及资源的使用。第二,我们已经确定,在集体辩论和共识之后,其中哪些应该用于特定的临床场景。在这个过程之后,对于患有糖尿病和足部溃疡的人,我们建议:(a)医疗保健专业人员之间的沟通:使用SINBAD(网站,缺血,细菌感染,面积和深度)系统(第一选项)或考虑使用WIfI(伤口,缺血,足部感染)系统(备选方案,当可用所需的设备和专业知识水平并且认为可行时),并且在每种情况下,应描述构成系统的各个变量,而不是总分;(b)预测特定个体的溃疡结果:不建议使用现有系统;(c)表征患有感染溃疡的人:使用IDSA/IWGDF分类(第一选择)或考虑使用WIfI系统(替代选项,在具备所需设备和专业知识水平且认为可行的情况下);(d)对患有外周动脉疾病的人进行定性:考虑使用WIfI系统作为对治愈可能性和截肢风险进行分层的手段;(e)对人群的结局进行审核:使用SINBAD评分。
结论:对于使用等级提出的所有建议,判断了证据的确定性,充其量,作为低。然而,基于当前数据的合理应用,这种方法允许提出建议,这可能具有临床效用。