Development of the Tardivo Algorithm to Predict Amputation Risk of Diabetic Foot

João Paulo Tardivo, Maurício S Baptista, João Antonio Correa, Fernando Adami, Maria Aparecida Silva Pinhal, João Paulo Tardivo, Maurício S Baptista, João Antonio Correa, Fernando Adami, Maria Aparecida Silva Pinhal

Abstract

Diabetes is a chronic disease that affects almost 19% of the elderly population in Brazil and similar percentages around the world. Amputation of lower limbs in diabetic patients who present foot complications is a common occurrence with a significant reduction of life quality, and heavy costs on the health system. Unfortunately, there is no easy protocol to define the conditions that should be considered to proceed to amputation. The main objective of the present study is to create a simple prognostic score to evaluate the diabetic foot, which is called Tardivo Algorithm. Calculation of the score is based on three main factors: Wagner classification, signs of peripheral arterial disease (PAD), which is evaluated by using Peripheral Arterial Disease Classification, and the location of ulcers. The final score is obtained by multiplying the value of the individual factors. Patients with good peripheral vascularization received a value of 1, while clinical signs of ischemia received a value of 2 (PAD 2). Ulcer location was defined as forefoot, midfoot and hind foot. The conservative treatment used in patients with scores below 12 was based on a recently developed Photodynamic Therapy (PDT) protocol. 85.5% of these patients presented a good outcome and avoided amputation. The results showed that scores 12 or higher represented a significantly higher probability of amputation (Odds ratio and logistic regression-IC 95%, 12.2-1886.5). The Tardivo algorithm is a simple prognostic score for the diabetic foot, easily accessible by physicians. It helps to determine the amputation risk and the best treatment, whether it is conservative or surgical management.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Wagner Classification for diabetic foot.
Fig 1. Wagner Classification for diabetic foot.
Grade 1, superficial ulcer; Grade 2, Deep ulcer; Grade 3, osteitis-infection and Grade 4, forefoot gangrene.
Fig 2. Location of foot injuries.
Fig 2. Location of foot injuries.
FF, forefoot; MF, midfoot; HF, hindfoot. The localization sites showed at the figure are important to define the grades to calculate the algorithm.
Fig 3. Strategic diagram of Tardivo Algorithm.
Fig 3. Strategic diagram of Tardivo Algorithm.
The diagram indicates the parameters significantly important to evaluate diabetic foot and obtain the score values.

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