Authors: MB Strauss, C Ko, LQ Lu, H Moon, Miller SS.
Introduction: Diabetic foot ulcers (DFUs) are the leading cause of morbidity and amputations in the diabetic population. The Long Beach Wound Score (LBWS) is a tool that provides objectivity to evaluation of DFUs and rationale for their management.
With both tested reliability and published validity, the LBWS is unique among diabetic foot as well as other wound classification systems in this regard and is fundamental to our algorithm.
Methods: We generated an algorithm that is based on the three wound types, i.e. Healthy, Problem, and End-stage objectively derived from the LBWS. Five assessments each graded from 2-points (best) to 0-points (worse) using objective criteria for each grade establishes the 0 to 10-point LBWS. Each wound type has specific management requirements and predicable outcomes.
Results: Our algorithm shows that Healthy wounds (7.5 to 10-points) heal with few exceptions with the simplest of interventions. Problem wounds (3.5 to 7-points) typically have remedial causes and will usually heal by correcting the causes. End-stage wounds invariable require an amputation for management. Salvage attempt versus major amputation of a wound in a Transition zone (2.5 to 4-points) requires information about the patient’s health status and intentions for management decisions.
Conclusions: Use of our algorithm based on the LBWS optimizes management, prevents delays in initiating needed interventions, quantifies improvement, and ensures cost effectiveness in managing wounds in general and DFUs in particular
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