The analysis for time of referral to a medical center among patients with diabetic foot infection.
Open accessAbstract
BACKGROUND: Diabetic foot infection (DFI) is a limb- and life-threatening complication for diabetic patients needing immediate and comprehensive treatment. Early referral of DFI patients to a diabetic foot center is recommended but there appears limited validated evidence, with the association between referral time and clinical outcomes of limb- preservation or in-hospital mortality still lacking. METHODS: This retrospective research studied consecutive type 2 diabetic patients with DFI treated at the major diabetic foot center in Taiwan from 2014 to 2017. Six hundred and sixty-eight patients presented with limb-threatening DFI. After stratifying their referral days into quartiles, the demographic information and clinical outcomes were analyzed. RESULTS: One hundred and seventy-two patients were placed in the first quartile (Q1) with less than 9 days of referral time; 164 in the second quartile (Q2) with 9-21 days; 167 in the third quartile (Q3) with 21-59 days; and 165 in the fourth quartile (Q4) with >59 days. End-stage renal disease (ESRD), major adverse cardiac events (MACE) and peripheral arterial disease (PAD) were noted as being higher in the Q4 group compared with the Q1 group (25.45% vs 20.35% in ESRD, 47.27% vs 26.16% in MACE and 78.79% vs 52.33% in PAD respectively). The Q1 group had more patients presenting with systemic inflammatory responsive syndrome (SIRS) (29.07% in Q1 vs 25.45% in Q4 respectively, P=0.019). Regarding poor outcome (major lower-extremity amputation (LEA) or in-hospital mortality), the Q4 group had 21.21% of patients in this category and the Q1 group had 10.47%. The odds ratio of each increased referral day on poor prognosis was 1.006 with 95% confidence interval 1.003-1.010 (P=<0.001). In subgroups, the impact on poor prognosis by day was most obvious in patients with SIRS (OR 1.011, 95% CI 1.004-1.018, P=0.003) and those with PAD (OR 1.004, 95% CI 1.001-1.008, P=0.028). CONCLUSIONS: The deferred referral of DFI patients to the diabetic foot center might be associated with poor treatment outcome either in major LEA or mortality, particularly in patients with SIRS or PAD. Both physician and patient awareness of disease severity and overcoming the referral barrier is suggested. TRIAL REGISTRATION: Not applicable.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
More recent trials did not show a significant effect of hyperbaric oxygen therapy.
“but more recent trials did not show a significant effect of hyperbaric oxygen therapy.52,71”
From Diabetic Foot Ulcers (2023) · cites this paper as [71]
The Results section examines referral timing and outcomes in patients with diabetic foot infection, not trials of hyperbaric oxygen therapy. Searches for “hyperbaric oxygen therapy” and randomized trials found no passage in our copy addressing whether that therapy had a significant effect. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The global burden of diabetic foot disease
Boulton, A. J. M., Vileikytė, L., Tennvall, G. R., & Apelqvist, J. (2005) · The Lancet · doi:10.1016/s0140-6736(05)67698-2 · Cited by 2,578 · see citing works
2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease
Gerhard-Herman, M. D., Gornik, H. L., Barrett, C., Barshes, N. R., Corriere, M. A., Drachman, D. E., Fleisher, L. A., Fowkes, F. G. R., Hamburg, N. M., Kinlay, S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.11.007 · Cited by 1,941 · see citing works
Lipsky, B. A., Berendt, A. R., Cornia, P. B., Pile, J. C., Peters, E. J. G., Armstrong, D. G., Deery, H. G., Embil, J. M., Joseph, W. S., Karchmer, A. W., et al. (2012) · Clinical Infectious Diseases · doi:10.1093/cid/cis346 · Cited by 1,771 · see citing works
Gerhard‐Herman, M. D., Gornik, H. L., Barrett, C., Barshes, N. R., Corriere, M. A., Drachman, D. E., Fleisher, L. A., Fowkes, F. G. R., Hamburg, N. M., Kinlay, S., et al. (2016) · Circulation · doi:10.1161/cir.0000000000000470 · Cited by 1,053 · see citing works
Prompers, L., Huijberts, M., Apelqvist, J., Jude, E., Piaggesi, A., Bakker, K., Edmonds, M., Holstein, P., Jirkovska, A., Mauricio, D., et al. (2007) · Diabetologia · doi:10.1007/s00125-006-0491-1 · Cited by 1,023 · see citing works
Peripheral arterial disease in people with diabetes
American Diabetes Association (2003) · Diabetes Care · doi:10.2337/diacare.26.12.3333 · Cited by 953 · see citing works
Peripheral arterial disease in people with diabetes: response to consensus statement.
Hoyt, R. (2004) · Diabetes Care · doi:10.2337/diacare.27.8.2095 · Cited by 556 · see citing works
Schaper, N. C. (2004) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.464 · Cited by 495 · see citing works
Prognosis of the infected diabetic foot ulcer: a 12‐month prospective observational study
Ndosi, M. E., Wright-Hughes, A. M., Brown, S. T., Backhouse, M. R., Lipsky, B. A., Bhogal, M., Reynolds, C., Vowden, P., Jude, E. B., Nixon, J., et al. (2017) · Diabetic Medicine · doi:10.1111/dme.13537 · Cited by 296 · see citing works
Lower-Extremity Peripheral Arterial Disease among Patients with End-Stage Renal Disease
O’Hare, A. M., & Johansen, K. L. (2001) · Journal of the American Society of Nephrology · doi:10.1681/asn.v12122838 · Cited by 284 · see citing works
Peripheral Arterial Disease in Patients With End-Stage Renal Disease
Rajagopalan, S., Dellegrottaglie, S., Furniss, A., Gillespie, B. W., Satayathum, S. S., Lameire, N. H., Saitō, A., Akiba, T., Jadoul, M. Y., Ginsberg, N., et al. (2006) · Circulation · doi:10.1161/circulationaha.105.607390 · Cited by 273 · see citing works
Narres, M., Kvitkina, T., Claessen, H., Droste, S., Schuster, B., Morbach, S., Rümenapf, G., Acker, K. L. V., & Icks, A. (2017) · PLoS ONE · doi:10.1371/journal.pone.0182081 · Cited by 260 · see citing works
DELUCA, G. (2004) · European Heart Journal · doi:10.1016/j.ehj.2004.03.021 · Cited by 232 · see citing works
Prompers, L., Huijberts, M. S., Apelqvist, J., Jude, E. B., Piaggesi, A., Bakker, K., Edmonds, M. E., Holstein, P., Jirkovská, A., Mauricio, D., et al. (2008) · Diabetic Medicine · doi:10.1111/j.1464-5491.2008.02445.x · Cited by 203 · see citing works
Diabetic foot infections: stepwise medical and surgical management
Armstrong, D. G., & Lipsky, B. A. (2004) · International Wound Journal · doi:10.1111/j.1742-4801.2004.00035.x · Cited by 197 · see citing works
Lipsky, B. A., Berendt, A. R., Cornia, P. B., Pile, J. C., Peters, E. J. G., Armstrong, D. G., Deery, H. G., Embil, J. M., Joseph, W. S., Karchmer, A. W., et al. (2012) · Clinical Infectious Diseases · doi:10.1093/cid/cis460 · Cited by 170 · see citing works
Obara, H., Matsubara, K., & Kitagawa, Y. (2018) · Annals of Vascular Diseases · doi:10.3400/avd.ra.18-00074 · Cited by 114 · see citing works
Lin, C.-W., Armstrong, D. G., Lin, C.-H., Liu, P., Hung, S., Lee, S., Huang, C., & Huang, Y. (2019) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2019-000795 · Cited by 92 · see citing works
Self-citationManu, C. A., Lacopi, E., Bouillet, B., et al. (2018) · Journal of Wound Care · doi:10.12968/jowc.2018.27.3.186 · Cited by 73 · see citing works
Lin, C.-W., Hsu, L., Chen, C., et al. (2010) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2010.08.002 · Cited by 58 · see citing works
Self-citationHuang, Y., Lin, K., Jiang, Y., et al. (2012) · Journal of the Formosan Medical Association · doi:10.1016/j.jfma.2012.09.006 · Cited by 56 · see citing works
Self-citationPathophysiology of chronic limb ischemia
Simon, F., Oberhuber, A., Floros, N., et al. (2018) · Gefässchirurgie · doi:10.1007/s00772-018-0380-1 · Cited by 49 · see citing works
INFECTION IN THE ISCHEMIC LOWER EXTREMITY
Fry, D. E., Marek, J. M., & Langsfeld, M. (1998) · Surgical Clinics of North America · doi:10.1016/s0039-6109(05)70326-1 · Cited by 32 · see citing works
Lin, C.-W., Hsu, B. R., Tsai, J.-S., Yang, H., Lin, J., Lin, C.-H., Huang, C., Hung, S., & Huang, Y. (2016) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2016.09.011 · Cited by 32 · see citing works
Self-citationAcute and critical limb ischemia: When time is limb
Shishehbor, M. H. (2014) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.81gr.13003 · Cited by 28 · see citing works
Patient and professional delay in the referral trajectory of patients with diabetic foot ulcers
Sanders, A. P., Stoeldraaijers, L., Pero, M. W. M., et al. (2013) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2013.09.016 · Cited by 26 · see citing works
Formation of plasma advanced glycosylation end products (AGEs) has no influence on plasma viscosity
Mellinghoff, A. C., Reininger, A. J., Wuerth, J.-P., Founds, H., Landgraf, R., & Hepp, K. D. (1997) · Diabetic Medicine · doi:10.1002/(sici)1096-9136(199710)14:10 · Cited by 24 · see citing works
Treatment for Diabetic Foot Ulcers Complicated by Major Cardiac Events
Hung, S., Huang, Y., Hsu, L., et al. (2015) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2014.11.002 · Cited by 14 · see citing works
Self-citationLin, C.-W., Hung, S., Huang, C., Yeh, J., & Huang, Y. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8101538 · Cited by 13 · see citing works
Self-citationAbreu, L. M. (2019) · Arquivos Brasileiros de Cardiologia · doi:10.5935/abc.20190059 · Cited by 8 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Armstrong, D. G., Tan, T.-W., Boulton, A. J. M., & Bus, S. A. (2023) · JAMA · doi:10.1001/jama.2023.10578 · Cited by 1,658 · see citing works
- Authors
- Lin, C.-W., Yang, H.-M., Hung, S.-Y., Chen, I.-W., & Huang, Y.-Y.
- Affiliations
- Chang Gung Memorial Hospital (TW)
- Chang Gung University (TW)
- Corresponding author
- Huang, Yu-Yao
- Venue
- BMC Family Practice
- Published
- 2021-01-09
- Volume
- 22
- Issue
- 1
- Pages
- 16-16
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC7797140
- OpenAlex
- W3118784196
- Cited by
- 24
- References
- 30
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 5 · 2023: 7 · 2022: 2 · 2021: 1
- FWCI
- 2.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Family Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Chang Gung Memorial Hospital, Linkou (CORPG3J0021)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Health Sciences › Medicine › Surgery › Orthopedic Infections and Treatments
- Keywords
- diabetic foot infection, referral timing, type 2 diabetes, lower limb amputation, in-hospital mortality, systemic inflammatory response syndrome, peripheral arterial disease, end-stage renal disease, major adverse cardiac events, limb salvage, prognosis, Taiwan
- MeSH terms
- Amputation, Surgical, Diabetes Mellitus, Humans, Referral and Consultation, Retrospective Studies, Risk Factors, Treatment Outcome, Diabetic Foot
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
