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- Author or Editor: GW Edelson x
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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 debridement, 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.
The authors reviewed the admission leukocyte indices of 338 consecutive admissions (203 males, 135 females, mean age of 60.2 +/- 12.9 years) with a primary diagnosis of diabetic foot infection in a multicenter retrospective study. The mean white blood cell count on admission for all subjects studied was calculated at 11.9 +/- 5.4 x 103 cells/mm3. Of all white blood cell counts secured for patients admitted with a diabetic foot infection, 56% (189 out of 338) were within normal limits. The average automated polymorphonuclear leukocyte percentage was calculated at 71.4 +/- 11.1% (normal range 40% to 80%). Normal polymorphonuclear leukocyte values were present in 83.7% of subjects. The authors stress that the diagnosis of a diabetic pedal infection is made primarily on the basis of clinical signs and symptoms, and that a normal white cell count and white cell differential should not deter the physician from taking appropriate action to mitigate the propagation of a potentially limb-threatening pedal infection.
