Chappell, Francesca M and Crawford, Fay and Horne, Margaret and Leese, Graham P and Martin, Angela and Weller, David and Boulton, Andrew JM and Abbott, Caroline and Monteiro-Soares, Matilde and Veves, Aristidis and Riley, Richard D (2021) Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies. BMJ Open Diabetes Research and Care, 9 (1). e002150-e002150. DOI https://doi.org/10.1136/bmjdrc-2021-002150
Chappell, Francesca M and Crawford, Fay and Horne, Margaret and Leese, Graham P and Martin, Angela and Weller, David and Boulton, Andrew JM and Abbott, Caroline and Monteiro-Soares, Matilde and Veves, Aristidis and Riley, Richard D (2021) Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies. BMJ Open Diabetes Research and Care, 9 (1). e002150-e002150. DOI https://doi.org/10.1136/bmjdrc-2021-002150
Chappell, Francesca M and Crawford, Fay and Horne, Margaret and Leese, Graham P and Martin, Angela and Weller, David and Boulton, Andrew JM and Abbott, Caroline and Monteiro-Soares, Matilde and Veves, Aristidis and Riley, Richard D (2021) Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies. BMJ Open Diabetes Research and Care, 9 (1). e002150-e002150. DOI https://doi.org/10.1136/bmjdrc-2021-002150
Abstract
Introduction The aim of the study was to develop and validate a clinical prediction rule (CPR) for foot ulceration in people with diabetes. Research design and methods Development of a CPR using individual participant data from four international cohort studies identified by systematic review, with validation in a fifth study. Development cohorts were from primary and secondary care foot clinics in Europe and the USA (n=8255, adults over 18 years old, with diabetes, ulcer free at recruitment). Using data from monofilament testing, presence/absence of pulses, and participant history of previous ulcer and/or amputation, we developed a simple CPR to predict who will develop a foot ulcer within 2 years of initial assessment and validated it in a fifth study (n=3324). The CPR’s performance was assessed with C-statistics, calibration slopes, calibration-in-the-large, and a net benefit analysis. Results CPR scores of 0, 1, 2, 3, and 4 had a risk of ulcer within 2 years of 2.4% (95% CI 1.5% to 3.9%), 6.0% (95% CI 3.5% to 9.5%), 14.0% (95% CI 8.5% to 21.3%), 29.2% (95% CI 19.2% to 41.0%), and 51.1% (95% CI 37.9% to 64.1%), respectively. In the validation dataset, calibration-in-the-large was −0.374 (95% CI −0.561 to −0.187) and calibration slope 1.139 (95% CI 0.994 to 1.283). The C-statistic was 0.829 (95% CI 0.790 to 0.868). The net benefit analysis suggested that people with a CPR score of 1 or more (risk of ulceration 6.0% or more) should be referred for treatment. Conclusion The clinical prediction rule is simple, using routinely obtained data, and could help prevent foot ulcers by redirecting care to patients with scores of 1 or above. It has been validated in a community setting, and requires further validation in secondary care settings.
Item Type: | Article |
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Uncontrolled Keywords: | Adolescent; Adult; Clinical Decision Rules; Cohort Studies; Diabetes Mellitus; Diabetic Foot; Europe; Humans; Ulcer |
Divisions: | Faculty of Science and Health Faculty of Science and Health > Health and Social Care, School of |
SWORD Depositor: | Unnamed user with email elements@essex.ac.uk |
Depositing User: | Unnamed user with email elements@essex.ac.uk |
Date Deposited: | 27 Sep 2024 11:33 |
Last Modified: | 30 Oct 2024 21:27 |
URI: | http://repository.essex.ac.uk/id/eprint/36000 |
Available files
Filename: chappell 2021.pdf