Abstract:
Introduction
Diabetic foot ulcers represent a major cause of morbidity and are frequently associated with infection,
delayed healing, and limb loss. Accurate risk stratification using standardized scoring systems is essential
for predicting outcomes and guiding management decisions. The present study aimed to evaluate and
compare three ulcer scoring systems (Diabetic Ulcer Severity Score (DUSS), Site, Ischemia, Neuropathy,
Bacterial Infection, Area, and Depth (SINBAD) scoring, and University of Texas classification) in predicting
clinical outcomes, specifically secondary healing, requirement of split-thickness skin grafting (STSG), and
lower limb amputation, among patients with diabetic foot ulcers.
Materials and methods
This prospective observational study included 107 patients aged ≥35 years with diabetic foot ulcers treated
at a tertiary care centre over two years. Ulcers were assessed at baseline using the Diabetic Ulcer Severity
Score, the University of Texas (UT) classification, and the SINBAD scoring system. Patients were followed
until a definitive outcome. Clinical outcomes were categorized as secondary healing, requirement of split
thickness skin grafting, or lower limb amputation. Non-parametric statistical analysis was performed using
the Kruskal-Wallis test, and a p-value <0.05 was considered statistically significant.
Results
The mean age of participants was 56.84 ± 12.32 years, with a male predominance (84, 78.3%). Most ulcers
were located in the midfoot (45, 42.1%) and forefoot (44, 41.1%). STSG was required in 84 (78.5%) patients,
amputation was performed in 18 (16.8%), and secondary healing occurred in five (4.7%). DUSS and UT
classification did not show statistically significant differences across outcome groups. In contrast, SINBAD
scores were significantly higher in the amputation group (median 5, IQR 4-6) compared to the STSG group
(median 4, IQR 3-5) and secondary healing group (median 2, IQR 1-2) (H=8.02, p=0.018), demonstrating
better discriminatory ability.
Conclusion
Among the evaluated scoring systems, SINBAD showed superior predictive performance for adverse clinical
outcomes and may serve as a practical tool for risk stratification in diabetic foot ulcer management.
