Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov;14(3):114-123.
doi: 10.5704/MOJ.2011.018.

Comparison of WIFi, University of Texas and Wagner Classification Systems as Major Amputation Predictors for Admitted Diabetic Foot Patients: A Prospective Cohort Study

P N Vera-Cruz  1 , P P Palmes  1 , Ljm Tonogan  2 , A H Troncillo  2
Affiliations

Comparison of WIFi, University of Texas and Wagner Classification Systems as Major Amputation Predictors for Admitted Diabetic Foot Patients: A Prospective Cohort Study

P N Vera-Cruz et al. Malays Orthop J. 2020 Nov.

Abstract

Introduction: Classifications systems are powerful tools that could reduce the length of hospital stay and economic burden. The Would, Ischemia, and Foot Infection (WIFi) classification system was created as a comprehensive system for predicting major amputation but is yet to be compared with other systems. Thus, the objective of this study is to compare the predictive abilities for major lower limb amputation of WIFi, Wagner and the University of Texas Classification Systems among diabetic foot patients admitted in a tertiary hospital through a prospective cohort design.

Materials and methods: Sixty-three diabetic foot patients admitted from June 15, 2019 to February 15, 2020. Methods included one-on-one interview for clinico-demographic data, physical examination to determine the classification. Patients were followed-up and outcomes were determined. Pearson Chi-square or Fisher's Exact determined association between clinico-demographic data, the classifications, and outcomes. The receiver operating characteristic (ROC) curve determined predictive abilities of classification systems and paired analysis compared the curves. Area Under the Receiver Operating Characteristic Curve (AUC) values used to compare the prediction accuracy. Analysis was set at 95% CI.

Results: Results showed hypertension, duration of diabetes, and ambulation status were significantly associated with major amputation. WIFi showed the highest AUC of 0.899 (p = 0.000). However, paired analysis showed AUC differences between WIFi, Wagner, and University of Texas classifications by grade were not significantly different from each other.

Conclusion: The WIFi, Wagner, and University of Texas classification systems are good predictors of major amputation with WIFi as the most predictive.

Keywords: University of Texas classification; WIFi; diabetic foot; major amputation; wagner.

PubMed Disclaimer

Figures

Fig. 1:
Fig. 1:
Conceptual Framework. Relationship Between Independent and Dependent Variables.
Fig. 2:
Fig. 2:
Flowchart for the Conduct of the study.
Fig. 3:
Fig. 3:
Receiver Operating Characteristic (ROC) curves of the three classification systems.
See this image and copyright information in PMC

References

    1. Addressing Asia’s fast growing diabetes epidemic. Bull World Health Organ. 2017;95:550–1. doi: 10.2471/BLT.17.020817. - DOI - PMC - PubMed
    1. Alcantara AS, Araza L, Mercado-Asis L, Tan-Alora A. Bacterial Infections among Filipino Diabetics at the Santo Tomas University Hospital. Phil J Microbiol Infect Dis. 1999;28(3):91–7.
    1. Reiber GE, Boyko EJ, Smith DG. Diabetes in America. 2nd ed. United States: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health; 1995. Lower extremity foot ulcers and amputations in diabetes; pp. 409–28. In: National Diabetes Data Group (NNDG).
    1. Frykberg RG, Armstrong DG, Giurini J, Edwards A, Kravette M, Kravitz S et al. Diabetic foot disorders: a clinical practice guideline. American College of Foot and Ankle Surgeons. J Foot Ankle Surg. 2000;39(5 suppl):S1–60. - PubMed
    1. Mills JL Sr, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI) J Vasc Surg. 2014;9(1):220–34. doi: 10.1016/j.jvs.2013.08.003. - DOI - PubMed

LinkOut - more resources