Abstract：
BACKGROUND: In this podcast, we present the result of the 2023 scheduled update of the 2019 guidelines of the International Working Group of the Diabetic Foot (IWGDF) addressing the use of systems to classify foot ulcers in people with diabetes in routine clinical practice.
METHODS: These guidelines were based on a systematic review of the available literature that identified 28 classifications addressed in 149 articles and, subsequently, expert opinion using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. We first assessed the value of each system independently and, in the second stage, chose the best one or two to be used in each clinical scenario.
RESULTS: We recommend (1) for communication among healthcare professionals to use the Site, Ischaemia, Neuropathy, Bacterial infection, Area, Depth (SINBAD) classification (first option) or consider using Wound, Ischaemia, foot Infection (WIfI) system (alternative option, when the required equipment and level of expertise are 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; (2) for predicting the outcome of an ulcer in a specific individual: no existing system could be recommended; (3) for characterising a person with an infected ulcer: the use of the IDSA (Infection Diseases Society of America)/IWGDF (first option) classification or consider using the WIfI system (alternative option, when the required equipment and level of expertise are available and it is considered as feasible); (4) for characterising a person with peripheral artery disease: consider using the WIfI system as a means to stratify healing likelihood and amputation risk; (5) for the audit of outcome(s) of populations: the use of the SINBAD score.
CONCLUSIONS: Although there is no classification that fits all purposes, it is crucial that healthcare professionals standardize the way they characterise diabetes-related foot ulcers and guide their decision-making process by using validated classification systems.
METHODS: These guidelines were based on a systematic review of the available literature that identified 28 classifications addressed in 149 articles and, subsequently, expert opinion using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. We first assessed the value of each system independently and, in the second stage, chose the best one or two to be used in each clinical scenario.
RESULTS: We recommend (1) for communication among healthcare professionals to use the Site, Ischaemia, Neuropathy, Bacterial infection, Area, Depth (SINBAD) classification (first option) or consider using Wound, Ischaemia, foot Infection (WIfI) system (alternative option, when the required equipment and level of expertise are 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; (2) for predicting the outcome of an ulcer in a specific individual: no existing system could be recommended; (3) for characterising a person with an infected ulcer: the use of the IDSA (Infection Diseases Society of America)/IWGDF (first option) classification or consider using the WIfI system (alternative option, when the required equipment and level of expertise are available and it is considered as feasible); (4) for characterising a person with peripheral artery disease: consider using the WIfI system as a means to stratify healing likelihood and amputation risk; (5) for the audit of outcome(s) of populations: the use of the SINBAD score.
CONCLUSIONS: Although there is no classification that fits all purposes, it is crucial that healthcare professionals standardize the way they characterise diabetes-related foot ulcers and guide their decision-making process by using validated classification systems.
摘要：
背景：在这个播客中，我们介绍了国际糖尿病足工作组(IWGDF)2019年指南2023年计划更新的结果,该指南涉及在常规临床实践中使用系统对糖尿病患者足部溃疡进行分类.
方法：这些指南基于对现有文献的系统回顾，这些文献确定了149篇文章中涉及的28种分类，随后,使用建议分级的专家意见，评估,发展,和评价(等级)方法。我们首先独立评估每个系统的价值，在第二阶段,选择最好的一种或两种用于每种临床方案。
结果：我们建议（1）医疗保健专业人员之间的沟通使用本网站，缺血,神经病,细菌感染,区域,深度（SINBAD）分类（第一选项）或考虑使用伤口，缺血,足部感染(WIfI)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；（2）用于预测特定个体的溃疡结果：不建议使用现有系统；（3）用于表征患有感染溃疡的人：使用IDSA（美国感染疾病协会）/IWGDF（第一选项）分类或考虑使用WfI选项当具备所需的设备和专业知识水平并且认为可行时）；（4）对患有外周动脉疾病的人进行表征：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方法；（5）对人群的结局进行审核：使用SINBAD评分。
结论：尽管没有适合所有目的的分类，至关重要的是，医疗保健专业人员应使用经过验证的分类系统来规范他们对糖尿病相关足部溃疡的表征方式，并指导他们的决策过程。
方法：这些指南基于对现有文献的系统回顾，这些文献确定了149篇文章中涉及的28种分类，随后,使用建议分级的专家意见，评估,发展,和评价(等级)方法。我们首先独立评估每个系统的价值，在第二阶段,选择最好的一种或两种用于每种临床方案。
结果：我们建议（1）医疗保健专业人员之间的沟通使用本网站，缺血,神经病,细菌感染,区域,深度（SINBAD）分类（第一选项）或考虑使用伤口，缺血,足部感染(WIfI)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；（2）用于预测特定个体的溃疡结果：不建议使用现有系统；（3）用于表征患有感染溃疡的人：使用IDSA（美国感染疾病协会）/IWGDF（第一选项）分类或考虑使用WfI选项当具备所需的设备和专业知识水平并且认为可行时）；（4）对患有外周动脉疾病的人进行表征：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方法；（5）对人群的结局进行审核：使用SINBAD评分。
结论：尽管没有适合所有目的的分类，至关重要的是，医疗保健专业人员应使用经过验证的分类系统来规范他们对糖尿病相关足部溃疡的表征方式，并指导他们的决策过程。
