The S(AD)SAD Classification of Macfarlane et al for Diabetic Foot Ulcers

Macfarlane et al developed the S(AD)SAD classification for diabetic foot ulcers. The authors are from City Hospital in Nottingham, England.

Patient selection: diabetic patient

Parameters:

(1) skin area

(2) skin depth

(3) sepsis (infection)

(4) arteriopathy

(5) denervation

Parameter	Finding	Points
skin area	intact	0
	ulcer < 1 square cm	1
	ulcer 1 to 3 square cm	2
	ulcer > 3 square cm	3
skin depth	skin intact	0
	superficial (skin, subcutaneous tissue)	1
	tendon, joint capsule, periosteum	2
	bone or joint space	3
sepsis	none	0
	surface	1
	cellulitis	2
	osteomyelitis	3
arteriopathy	pedal pulses intact	0
	pedal pulses reduced or one missing	1
	both pedal pulses absent	2
	gangrene	3
denervation	pin pricks intact	0
	pin pricks reduce	1
	pin pricks absent	2
	Charcot joint	3

total score =

= SUM(points for all 5 parameters)

Interpretation:

• minimum score: 0

• maximum score: 15

• The higher the score the more severe the foot ulcer.

• A score <= 9 at baseline is associated with healting at 6 months (Parisi et al).

Performance at cutoff (Parisi et al):

• The sensitivity is 88% and specificity 52%.

• The accuracy was 70%.

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