{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:29:26Z","timestamp":1753878566313,"version":"3.41.2"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T00:00:00Z","timestamp":1727481600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>A diabetes\u2010related foot ulcer (DFU) is a major risk factor for lower\u2010extremity amputation (LEA). To help clinicians predict the risk of LEA in people with DFU, the Diabetic Foot Risk Assessment (DIAFORA) system was developed but has never been externally validated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this study, 317 people presenting with a new DFU were included. At baseline, participants were grouped into three groups based on their DIAFORA score: low\u2010risk (&lt;15), medium\u2010risk (15\u201325), and high\u2010risk (&gt;25). Participants were followed until healing, LEA, death, or at least 3\u2009months. Discriminative accuracy was evaluated using sensitivity, specificity, likelihood ratios (LRs) and the area under the curve (AUC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All 317 participants completed at least 3\u2009months of follow\u2010up for a median duration of 146\u2009days, during which 12.6% underwent minor amputation and 2.5% major amputation. People in the low\u2010 and medium\u2010risk categories had major amputation rates of 0.9% and 2.1%, respectively, and negative LR of major LEA of 0.10 and 0.38, respectively, while the people in the high\u2010risk category had an amputation rate of 25.0% and a positive LR of 12.9. The DIAFORA risk groups had a sensitivity of 75.0% and a specificity of 65.7%, with a corresponding AUC of 0.78 (95% CI 0.68\u20130.87) for the prediction of major LEA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The DIAFORA score is a useful tool for risk stratification of people presenting with a newly occurred DFU, with the external validation presenting results similar to those presented in the original study. The DIAFORA score may guide clinicians towards more individualized DFU treatment regimens.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.15443","type":"journal-article","created":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T17:34:58Z","timestamp":1727544898000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["External validation of the DIAFORA system to predict lower\u2010extremity amputations in a prospective Danish cohort"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4578-1328","authenticated-orcid":false,"given":"Johan","family":"R\u00f8ikjer","sequence":"first","affiliation":[{"name":"Steno Diabetes Center North Denmark Aalborg University Hospital  Aalborg Denmark"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4586-2910","authenticated-orcid":false,"given":"Matilde","family":"Monteiro\u2010Soares","sequence":"additional","affiliation":[{"name":"Portuguese Red Cross School of Health\u2014Lisbon  Lisbon Portugal"},{"name":"MEDCIDS\u2014Departamento de Medicina da Comunidade Informa\u00e7\u00e3o e Decis\u00e3o em Sa\u00fade Faculty of Medicine of the University of Porto  Porto Portugal"},{"name":"RISE@CINTESIS Faculty of Medicine Oporto University  Porto Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0555-071X","authenticated-orcid":false,"given":"Daina","family":"Walton","sequence":"additional","affiliation":[{"name":"Lewisham and Greenwich NHS Trust Foot Health Service  London UK"},{"name":"Department of Biosciences and Medicine University of Surrey  Surrey UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9007-9378","authenticated-orcid":false,"given":"Elisabetta","family":"Iacopi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery Endocrine\u2010Metabolic and of Transplantation University of Pisa  Italy"}]},{"given":"Jarmila","family":"Jirkovska","sequence":"additional","affiliation":[{"name":"Medical Department of the First Faculty of Medicine and Military University Hospital Prague Diabetes Center and Foot Clinic  Czech Republic"}]},{"given":"Michael","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Diabetic Foot Clinic and Diabetic Department King's College Hospital  London UK"},{"name":"Department of Diabetes, Faculty of Life Sciences and Medicine King's College, Strand  London UK"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6471-5043","authenticated-orcid":false,"given":"Anna","family":"Trocha","sequence":"additional","affiliation":[{"name":"Clinical Diabetes Center Elisabeth Hospital Essen  Essen Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1744-7576","authenticated-orcid":false,"given":"William","family":"Jeffocate","sequence":"additional","affiliation":[{"name":"Retired Physician Nottingham University Hospitals NHS Trust  UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8357-9163","authenticated-orcid":false,"given":"Sicco","family":"Bus","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, University of Amsterdam Department of Rehabilitation Medicine  Amsterdam The Netherlands"},{"name":"Amsterdam Movement Sciences, Rehabilitation and Development program  Amsterdam The Netherlands"}]},{"name":"the Diabetic Foot Study Group (DFSG) prevention of the first ulcer research group","sequence":"additional","affiliation":[]}],"member":"311","published-online":{"date-parts":[[2024,9,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-005-1856-6"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.14725"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcl140"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2634"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-12-0279"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2785"},{"key":"e_1_2_8_8_1","first-page":"40","article-title":"Definitions and criteria for diabetes\u2010related foot disease (IWGDF 2023 update)","volume":"2024","author":"Netten JJ","journal-title":"Diabetes Metab Res Rev"},{"key":"e_1_2_8_9_1","unstructured":"HansenCS EldrupE Yderstr\u00e6deK VindBF AndersenST R\u00f8ikjerJ HommelE DuunE J\u00f8rgensenLB Ejskj\u00e6rN. 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