A systematic review and meta-analysis of tests to predict wound healing in diabetic foot.
Open accessAbstract
Background This systematic review summarized the evidence on noninvasive screening tests for the prediction of wound healing and the risk of amputation in diabetic foot ulcers.Methods We searched MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Scopus from database inception to October 2011. We pooled sensitivity, specificity, and diagnostic odds ratio (DOR) and compared test performance.Results Thirty-seven studies met the inclusion criteria. Eight tests were used to predict wound healing in this setting, including ankle-brachial index (ABI), ankle peak systolic velocity, transcutaneous oxygen measurement (TcPo2), toe-brachial index, toe systolic blood pressure, microvascular oxygen saturation, skin perfusion pressure, and hyperspectral imaging. For the TcPo2 test, the pooled DOR was 15.81 (95% confidence interval [CI], 3.36-74.45) for wound healing and 4.14 (95% CI, 2.98-5.76) for the risk of amputation. ABI was also predictive but to a lesser degree of the risk of amputations (DOR, 2.89; 95% CI, 1.65-5.05) but not of wound healing (DOR, 1.02; 95% CI, 0.40-2.64). It was not feasible to perform meta-analysis comparing the remaining tests. The overall quality of evidence was limited by the risk of bias and imprecision (wide CIs due to small sample size).Conclusions Several tests may predict wound healing in the setting of diabetic foot ulcer; however, most of the available evidence evaluates only TcPo2 and ABI. The overall quality of the evidence is low, and further research is needed to provide higher quality comparative effectiveness evidence.
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WIfI scores of 1, 2, 3, and 4 were associated with 1-year amputation rates of 0%, 8%, 11%, and 38%, respectively.
“WIfI scores of 1, 2, 3, and 4 were associated with 1-year amputation rates of 0%, 8%, 11%, and 38%, respectively.39”
From Diabetic Foot Ulcers (2023) · cites this paper as [39]
The Study selection and Discussion sections list the tests evaluated, but do not include WIfI. Searches for WIfI and the stated one-year amputation rates found no passage reporting rates by WIfI score in our copy. (LLM, conf=0.77)
Experimental — accuracy not yet measuredThe Wound, Ischemia, Foot Infection (WIfI) classification system was developed and validated as a method to combine wound, ischemia, and foot infection and to accurately assess the risk of limb loss for patients with diabetic foot ulcers.
“TheWound, Ischemia, Foot Infection (WIfI) classification system was developed and validated as a method to combine all 3 variables (wound, ischemia, and foot infection)and to accurately assess the risk of limb loss for patients with diabetic foot ulcers.38,39”
From Diabetic Foot Ulcers (2023) · cites this paper as [39]
The Study selection section lists eight noninvasive tests evaluated for healing and amputation outcomes, but not WIfI. Searches for WIfI and for a classification combining wound, ischemia, and infection found no passage about its development, validation, or accuracy in assessing limb-loss risk. Page numbers were unavailable in our copy. (LLM, conf=0.76)
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- Authors
- Wang, Z., Hasan, R., Firwana, B., Elraiyah, T., Tsapas, A., Prokop, L., Mills, J. L., & Murad, M. H.
- Affiliations
- Mayo Clinic (US)
- University of Arizona (US)
- Corresponding author
- Murad, Mohammad Hassan
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2016-02
- Volume
- 63
- Issue
- 2
- Pages
- 29S-36S.e2
- ISSN
- 0741-5214 (ISSN-L)
- OpenAlex
- W2261074806
- Cited by
- 173
- References
- 51
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 17 · 2023: 18 · 2022: 27 · 2021: 25 · 2020: 24 · 2019: 13 · 2018: 13 · 2017: 7 · 2016: 5
- FWCI
- 1.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Rehabilitation › Wound Healing and Treatments
- Keywords
- diabetic foot ulcer, wound healing prediction, amputation risk, ankle-brachial index, transcutaneous oxygen tension, toe-brachial index, skin perfusion pressure, hyperspectral imaging, diagnostic accuracy
- MeSH terms
- Aged, Aged, 80 and over, Amputation, Surgical, Ankle, Female, Forecasting, Humans, Male, Middle Aged, Oxygen, Skin, Toes, Wound Healing, Diabetic Foot, Ankle Brachial Index
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