Systematic review of methods to diagnose infection in foot ulcers in diabetes

被引:52
|
作者
O'Meara, S
Nelson, EA
Golder, S
Dalton, JE
Craig, D
Iglesias, C
机构
[1] Univ York, Dept Hlth Sci, York YO10 5DD, N Yorkshire, England
[2] Univ York, Ctr Reviews & Disseminat, York YO10 5DD, N Yorkshire, England
[3] Univ York, Dept Econ & Related Studies, York YO10 5DD, N Yorkshire, England
[4] Manchester Royal Infirm, Dept Diabet Med, Manchester, Lancs, England
[5] Univ Warwick, Dept Biol Sci, Coventry CV4 7AL, W Midlands, England
[6] Univ Warwick, Dept Primary Care, Coventry CV4 7AL, W Midlands, England
[7] Univ Hosp Coventry, Dept Gen & Vasc Surg, Coventry, W Midlands, England
[8] Univ Hosp Warwickshire, Dept Gen & Vasc Surg, Coventry, W Midlands, England
[9] Univ Hosp Warwickshire, Dept Gen Med, Coventry, W Midlands, England
[10] Univ Hosp Coventry, Dept Gen Med, Coventry, W Midlands, England
[11] Univ Hosp Coventry, Dept Pathol, Coventry, W Midlands, England
[12] Univ Hosp Warwickshire, Dept Pathol, Coventry, W Midlands, England
关键词
diabetic foot ulcer; diagnosis; infection; systematic review;
D O I
10.1111/j.1464-5491.2006.01830.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aim To undertake a systematic review of the diagnostic performance of clinical examination, simple acquisition and sample analysis in infected foot ulcers in diabetes. Methods Nineteen electronic databases plus other sources were searched. To be included, studies had to fulfil the following criteria: (i) compare a method of clinical assessment, sample collection or sample analysis with a reference standard; (ii) recruit diabetic individuals with foot ulcers; (ii) present 2 x 2 diagnostic data. Studies were critically appraised using a 12-item checklist. Results Three eligible studies were identified, one each on clinical examination, sample collection and sample analysis. For all three, study groups were heterogeneous with respect to wound type and a small proportion of participants had foot ulcers due to diabetes. No studies identified an optimum reference standard. Other methodological problems included non-blind interpretation of tests and the time lag between index and reference tests. Individual signs or symptoms of infection did not prove to be Useful tests when assessed against punch biopsy as the reference standard. The wound swab did not perform well when assessed against tissue biopsy. Semiquantitative analysis of wound swab might be a useful alternative to quantitative analysis. The limitations of these findings and their impact on recommendations from relevant clinical guidelines are discussed. Conclusion Given the importance of this topic, it is surprising that only three eligible studies were identified. It was not possible to describe the optimal methods of diagnosing infection in diabetic patients with foot ulceration from the evidence identified in this systematic review.
引用
收藏
页码:341 / 347
页数:7
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