{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T10:04:08Z","timestamp":1779789848808,"version":"3.53.1"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T00:00:00Z","timestamp":1777766400000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Endocrino Diabet &amp;amp; Metabol"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This study aimed to validate and compare six IWGDF\u2010approved classification systems for predicting poor prognostic outcomes in diabetic foot ulcers (DFUs), using the same sample in Iran. We also proposed modifications to enhance the performance and feasibility of these tools, in outpatient setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective cohort study was conducted involving 616 DFUs from 400 patients over a six\u2010month period. We assessed the performance of six wound classification systems: Wagner, UTWCS, PEDIS\/IDSA, SINBAD, WIFI, and DiaFORA. We adjusted for the key variables associated with poor outcomes that could affect the performance of these systems, employing ten machine learning techniques along with the Least Absolute Shrinkage and Selection Operator (LASSO) and random forest methods for feature selection methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our findings indicated that both the SINBAD and UTWCS systems exhibited comparable effectiveness in predicting outcomes, significantly surpassing other systems. Notably, modifications to the WIFI system\u2014specifically, redefining the wound depth classification to a clearer category\u2014yielded improved predictive capabilities, outperforming the existing systems like SINBAD and UTWCS in predicting poor prognostic outcomes in outpatient setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SINBAD and UTWCS systems yield the best performance in our samples. Our proposed modification on the WIFI system can enhance its applicability for outpatient services according to reported performances.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/edm2.70193","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:20:44Z","timestamp":1777868444000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predicting Diabetic Foot Ulcer Outcomes: Machine Learning\u2010Based Refinement of\n                    <scp>IWGDF<\/scp>\n                    \u2010Approved Classifications for Outpatient Services"],"prefix":"10.1002","volume":"9","author":[{"given":"Farideh","family":"Mostafavi","sequence":"first","affiliation":[{"name":"Student Research Committee, School of Public Health and Safety Shahid Beheshti University of Medical Sciences  Tehran Iran"},{"name":"Department of Epidemiology, School of Public Health and Safety Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Reza","family":"Amini","sequence":"additional","affiliation":[{"name":"Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute Tehran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9837-4956","authenticated-orcid":false,"given":"Yadollah","family":"Mehrabi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health and Safety Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melina","family":"Rezvani","sequence":"additional","affiliation":[{"name":"Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute Tehran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehrangiz","family":"Toutounchi","sequence":"additional","affiliation":[{"name":"Department of Photo Healing and Regeneration Medical Laser Research Center, Yara Institute, ACECR  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0883-3408","authenticated-orcid":false,"given":"Seyed Saeed","family":"Hashemi Nazari","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health and Safety Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/CWCMR.S98762"},{"issue":"2","key":"e_1_2_11_3_1","first-page":"112","article-title":"IWGDF Diagnosis and Treatment of Diabetic Foot Wound Infections: Local Practical Guide","volume":"79","author":"Amini M. 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