Lipsky et al developed a risk score for predicting lower extremity amputation in a diabetic patient admitted for a diabetic foot infection. This can help to identify a patient who may benefit from more aggressive management. The authors are from Veterans Administration Pugent Sound Health Care System, University of Washington Seattle, Medical College of Wisconsin, Harvard Medical School and CareFusion (Marlborough, Massachusetts).
Patient selection: infected diabetic foot ulcer
Parameters:
(1) kidney disease (chronic or serum creatinine > 3 mg/dL)
(2) gender
(4) age in years
(5) type of infection
(6) history of amputation
(7) serum albumin in g/dL
(8) history of peripheral vascular disease
(9) white blood cell count
(10) transferred from other acute care facility
|
Parameter |
Finding |
Points |
|
kidney disorder |
Absent |
0 |
|
|
Present |
1 |
|
gender |
Female |
0 |
|
|
Male |
1 |
|
body temperature |
< 96°F |
2 |
|
|
96 to 100.5°F |
0 |
|
|
> 100.5°F |
2 |
|
age in years |
< 50 years |
0 |
|
|
>= 50 years |
4 |
|
type of infection |
cellulitis |
0 |
|
|
infected ulcer |
4 |
|
|
surgical site infection |
10 |
|
history of amputation |
No |
0 |
|
|
Yes |
4 |
|
serum albumin |
>= 2.8 g/dL |
0 |
|
|
< 2.8 g/dL |
5 |
|
history of peripheral vascular disease |
No |
0 |
|
|
Yes |
5 |
|
white blood cell count |
< 11,000 per µL |
0 |
|
|
>= 11,000 per µL |
7 |
|
transferred from other acute care facility |
No |
0 |
|
|
Yes |
12 |
where:
• Transfer from another acute care facility had a high weighting but was uncommon.
• The table has infected ulcer and surgical site infection as either/or since compared to cellulitis.
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 51
• The higher the score the greater the risk for amputation.
|
Score |
Risk of Amputation |
|
0 |
0% |
|
1 to 4 |
5% |
|
5 to 11 |
11% |
|
12 to 20 |
28% |
|
>= 21 |
50% |
Performance:
• The c-statistic is 0.76.
Specialty: Dermatology, Endocrinology, Surgery, general, Surgery, orthopedic
