Scottish Foot Ulcer Risk Score Predicts Foot Ulcer Healing in a Regional Specialist Foot Clinic

Abstract

OBJECTIVE—To determine whether patients developing ulcers had previously been identified as being at high risk of ulceration using the Scottish Care Information–Diabetes Collaboration (SCI-DC) ulcer risk score and whether the risk score predicts ulcer healing. RESEARCH DESIGN AND METHODS—All patients attending the diabetes foot clinic with an ulcer had been assessed for foot ulcer risk using the SCI-DC risk calculator, which categorizes patients into low, moderate, or high risk of ulceration. Information on foot pulses, neuropathy, foot deformity, previous ulcer, ulcer site, depth, and presence of sepsis was recorded and related to ulcer outcome. Patients were followed up until outcome was achieved (median 3 months [range 1–33]). RESULTS—Of patients attending the clinic with a foot ulcer (mean [±SD] age 67.3 ± 12.7 years, 68% male), 68% were previously recognized to be at high risk of foot ulceration, and 98% were high or moderate risk. Of 221 ulcers, the healing rate was 75% overall but was lower for high-risk patients compared with other patients (68 vs. 93%; P < 0.0001). Of the remainder, 3% became chronic ulcers, 12% required minor or major amputation, and 10% died with their ulcer. In multivariate analysis, absent pulses, neuropathy, increased age, and deep ulcers were associated with poor healing. The combination of neuropathy and ischemia was particularly associated with poor outcome of an ulcer (61% healing). CONCLUSIONS—The Scottish foot ulcer risk score predicts both ulcer development and ulcer healing. The risk score can be a useful initial guide to determine the likelihood of poor healing. The individual criteria contributing to this overall risk are similar to other studies.