From the Guidelines
The SINBAD system is the recommended scoring system for classifying diabetic foot ulcers, as it is simple, quick to use, and contains the necessary information to allow for triage by a specialist team 1. The SINBAD system grades Site, Ischaemia, Neuropathy, Bacterial infection, Area, and Depth as either 0 or 1 point, creating an easy to use scoring system that can achieve a maximum of 6 points. This system is preferred over others, such as the Wagner-Meggitt classification, due to its simplicity and ability to provide accurate information for triage without requiring complex or expensive equipment 1. Key factors to consider when using the SINBAD system include:
- Site: location of the ulcer
- Ischaemia: presence of poor blood flow
- Neuropathy: presence of nerve damage
- Bacterial infection: presence of infection
- Area: size of the ulcer
- Depth: depth of the ulcer The SINBAD system has been validated in 12 studies for several foot ulcer-related clinical outcomes, including healing, amputation, hospitalization, and death, with somewhat consistent results and substantial to good reliability 1. In contrast, other classification systems, such as the DIAFORA score and the Wagner-Meggitt classification, have limitations, including poor clinical discrimination and lack of external validation or reliability assessment 1. Therefore, the SINBAD system is the most appropriate choice for classifying diabetic foot ulcers and guiding management decisions 1.
From the Research
Scoring System for Diabetic Foot
The scoring system for diabetic foot is crucial in determining the severity of the condition and guiding treatment.
- Wagner's classification is a widely used grading system for lesions of the diabetic foot 2, 3.
- The classification system ranges from grade 0 to grade 5, with higher grades indicating more severe lesions 2.
- The Texas Classification System is another system used to assess the extent of foot lesions 4.
Stable versus Unstable Diabetic Foot
The stability of diabetic foot can be determined by the presence of infection, ischemia, and neuropathy.
- The Society for Vascular Surgery (SVS)-WIfI (Wound, Ischemia, Foot Infection) classification system can evaluate the benefit from revascularization and the risk of amputation in patients with diabetic foot infection 5.
- The Wagner-Meggitt classification can also predict the outcome of diabetic foot infection and determine factors associated with major amputation and mortality rate 5.
- A higher Wagner-Meggitt classification score is associated with high amputation rates in patients with diabetic foot infection 5.
Treatment of Diabetic Foot
The treatment of diabetic foot depends on the severity of the condition and the presence of complications.
- The STAGE principle is a wound treatment principle that emphasizes layer-by-layer incision, maintenance of effective wound drainage, and step-by-step treatment of the wound 6, 4.
- The principle can be combined with other wound treatment principles, such as the TIME and TIME-H principles, to eliminate the shortcomings of a single principle in wound management 4.
- Effective glycemic control, timely hospital admissions, and appropriate surgical/medical treatment can decrease morbidity and mortality due to diabetic foot disease 2, 3.