November 11, 1996

The Acutely Infected Diabetic Foot Is Not Adequately Evaluated in an Inpatient Setting

Author Affiliations

From the Division of Endocrinology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Mich (Dr Edelson), and the Department of Orthopaedics, University of Texas Health Science Center (Drs Armstrong and Lavery), the Department of Surgery, Kern Hospital for Special Surgery (Dr Caicco), and the Diabetic Foot Research Group (Drs Armstrong and Lavery), San Antonio, Tex.

Arch Intern Med. 1996;156(20):2373-2378. doi:10.1001/archinte.1996.00440190131013

Objective:  To evaluate the standard of evaluation and treatment of the infected diabetic foot ulceration at a 551-bed university teaching institution.

Design:  A retrospective review of a 4-year consecutive sample (1991-1994).

Population:  Two hundred fifty-five patients who were admitted to a hospital for care of an infected diabetic foot ulceration. Patients were subdivided into the following 4 dichotomous variables: (1) whether the patient underwent a lower-extremity amputation, (2) whether the patient was admitted once or multiple times, (3) whether the patient underwent intraoperative débridement, and (4) whether the patient was admitted to medical or surgical services.

Results:  All groups that were evaluated had undergone a less than adequate foot examination. Of the admitted patients, 31.4% did not have their pedal pulses documented; 59.7% of the admitted patients were not evaluated for the presence or absence of protective sensation. Nearly 90% of the wounds were not evaluated for involvement of underlying structures, and foot radiographs were not performed in 32.9% of the patients. There were more blood cultures ordered (62.0%) than wound cultures (51.4%).

Conclusion:  The results of this study highlight the need for a systematic, detailed lower-extremity examination for every diabetic patient who is admitted to a hospital, particularly those who are admitted with a primary diagnosis that involves a foot complication.Arch Intern Med. 1996;156:2373-2378