{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T21:07:32Z","timestamp":1771016852851,"version":"3.50.1"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,4,6]],"date-time":"2015-04-06T00:00:00Z","timestamp":1428278400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Funda\u00c3\u00a7\u00c3\u00a3o para a Ci\u00c3\u00aancia e a Tecnologia, IP (FCT)","award":["SFRH\/BD\/86201\/2"],"award-info":[{"award-number":["SFRH\/BD\/86201\/2"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>This study aimed to validate and compare the existing systems developed to stratify subjects with diabetic foot ulcers by risk of consequent lower extremity amputation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a prospective cohort study on a consecutive series of patients (mean age of 68 years; 64% male) with active ulcer who were attending our Hospital Diabetic Foot Clinic (<jats:italic>n<\/jats:italic>\u2009=\u2009293) from January 2010 to March 2013. At baseline, we collected information on the participants' characteristics and the relevant variables. Afterwards, we assessed the predictive value of each variable and each system's prognostic accuracy for amputation occurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During a median follow\u2010up of 91 days (interquartile range of 98), ulcers healed in 62% of the subjects. Major amputation occurred in 7% and minor occurred in 17%. Previous ulcer or amputation, ulcer area, and gangrene were associated with amputation occurrence. Nephropathy, pulses number, ulcer aetiology, depth, and number were associated with risk of amputation. Systems typically presented sensitivity values \u226580% and negative likelihood ratios \u22640.5 for the highest risk group; area under the receiver operating characteristic curve ranged from 0.56 to 0.83 and positive likelihood ratios from 1.0 to 5.9. If one chose only major amputation as an outcome, positive predictive values were lower, and negative predictive values tended to be higher.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>System stages, grades, scores, and\/or prognostics were generally associated with amputation, presenting overall substantial accuracy values. Nevertheless, great improvement is possible. A multicentre study validating and refining the existing systems is needed to improve clinical decision\u2010making in this area. Copyright \u00a9 2014 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/dmrr.2634","type":"journal-article","created":{"date-parts":[[2014,12,20]],"date-time":"2014-12-20T06:32:28Z","timestamp":1419057148000},"page":"515-529","source":"Crossref","is-referenced-by-count":35,"title":["Lower\u2010limb amputation following foot ulcers in patients with diabetes: classification systems, external validation and comparative analysis"],"prefix":"10.1002","volume":"31","author":[{"given":"Matilde","family":"Monteiro\u2010Soares","sequence":"first","affiliation":[{"name":"CIDES\/CINTESIS, Health Information and Decision Sciences Department, Faculty of Medicine University of Porto  Porto Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Martins\u2010Mendes","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Centro Hospitalar de Vila Nova de Gaia\/Espinho EPE  Vila Nova de Gaia Portugal"},{"name":"Diabetic Foot Clinic, Endocrinology, Diabetes and Metabolism Department Centro Hospitalar de Vila Nova de Gaia\/Espinho EPE  Vila Nova de Gaia Portugal"},{"name":"Department of Biochemistry, Faculty of Medicine University of Porto  Porto Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ant\u00f3nio","family":"Vaz\u2010Carneiro","sequence":"additional","affiliation":[{"name":"CIDES\/CINTESIS, Health Information and Decision Sciences Department, Faculty of Medicine University of Porto  Porto Portugal"},{"name":"Centre for Evidence\u2010Based Medicine, Faculty of Medicine University of Lisbon  Lisbon Portugal"},{"name":"Portuguese Collaborating Center of the Iberoamerican Cochrane Network  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u00e1rio","family":"Dinis\u2010Ribeiro","sequence":"additional","affiliation":[{"name":"CIDES\/CINTESIS, Health Information and Decision Sciences Department, Faculty of Medicine University of Porto  Porto Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,4,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.848"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2014.04.011"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1534734604266153"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1524-475X.1999.00007.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/1534734606297245"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1368-5031.2006.00899.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.464"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2535"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-0331"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2007.02189.x"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2003.06.006"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-0553"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2007.02308.x"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc05-2431"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2004.05.003"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2004.01275.x"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2005.01665.x"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc05-2031"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-0122"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/1403494807085314"},{"key":"e_1_2_8_22_1","doi-asserted-by":"crossref","unstructured":"World Health Organization.A global brief on hypertension: silent killer global public health crisis 2013. 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