The International Working Group of the Diabetic Foot (IWGDF) published an update to the 2019 guidelines to classify foot ulcers in people with diabetes. The guidelines are based on a systematic review of the available literature that identified 28 classifications addressed in 149 articles and expert opinion using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.
“Based on evidence and consensus judgement using the GRADE methodology, this guideline recommends the use of SINBAD as the priority wound classification system to utilize in people with diabetes and a foot ulcer,” the authors concluded.
The researchers first developed a list of classification systems considered “potentially adequate” for use in a clinical setting and focused on the usability, accuracy, and reliability of each system to predict ulcer-related complications as well as use of resources. Then, following group debate and consensus, the research team established which of them should be used in specific clinical scenarios.
Following this process, in a person with diabetes and a foot ulcer the researchers recommend:
- for communication among healthcare professionals: to use the SINBAD (Site, Ischaemia, Bacterial infection, Area and Depth) system (first option) or consider using WIfI (Wound, Ischaemia, foot Infection) system (alternative option, when the required equipment and level of expertise is available and it is considered feasible) and in each case the individual variables that compose the systems should be described rather than a total score
- for predicting the outcome of an ulcer in a specific individual: no existing system could be recommended
- for characterizing a person with an infected ulcer: the use of the Infectious Diseases Society of America/IWGDF classification (first option) or consider using the WIfI system (alternative option, when the required equipment and level of expertise is available and it is considered as feasible)
- for characterizing a person with peripheral artery disease: consider using the WIfI system as a means to stratify healing likelihood and amputation risk
- for the audit of outcome(s) of populations: the use of the SINBAD score.
The authors noted that evidence remains limited due to a lack of articles directly comparing the systems and may have a high risk of bias by focusing on healing or amputation.
