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How to Create a Hot Foot Line to Prevent Diabetes-Related Amputations: Instant Triage for Emergency Department and Inpatient Consultations

John D. Miller Southwestern Academic Limb Salvage Alliance (SALSA) Department of Surgery, Section of Vascular Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA.

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Eric J. Lew Center for the High-Risk Lower Extremity, University of New Mexico College of Medicine, Albuquerque, NM.

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Nicholas A. Giovinco Southwestern Academic Limb Salvage Alliance (SALSA) Department of Surgery, Section of Vascular Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA.

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Christian Ochoa Southwestern Academic Limb Salvage Alliance (SALSA) Department of Surgery, Section of Vascular Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA.

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Vincent L. Rowe Southwestern Academic Limb Salvage Alliance (SALSA) Department of Surgery, Section of Vascular Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA.

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Leonardo C. Clavijo Southwestern Academic Limb Salvage Alliance (SALSA) Department of Surgery, Section of Vascular Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA.

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Fred Weaver Southwestern Academic Limb Salvage Alliance (SALSA) Department of Surgery, Section of Vascular Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA.

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David G. Armstrong Southwestern Academic Limb Salvage Alliance (SALSA) Department of Surgery, Section of Vascular Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA.

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Emergency department visits for lower extremity complications of diabetes are extremely common throughout the world. Surprisingly, recent data suggest that such visits generate an 81.2% hospital admission rate with an annual bill of at least $1.2 billion in the United States alone. The likelihood of amputation and other subsequent adverse outcomes is strongly associated with three factors: 1) wound severity (degree of tissue loss), 2) ischemia, and 3) foot infection. Using these factors, this article outlines the basic principles needed to create an evidence-based, rapid foot assessment for diabetic foot ulcers presenting to the emergency department, and suggests the establishment of a “hot foot line” for an organized, expeditious response from limb salvage team members. We present a nearly immediate assessment and referral system for patients with atraumatic tissue loss below the knee that has the potential to vastly expedite lower extremity triage in the emergency room setting through greater collaboration and organization.

Corresponding author: David G. Armstrong, DPM, MD, PhD, Southwestern Academic Limb Salvage Alliance (SALSA) Department of Surgery Keck Medical Center of USC 1520 San Pablo Street, Suite 4300 Los Angeles, CA 90033. (E-mail: armstrong@usa.net)