Comparative Evaluation of the Wagner and University of Texas Classification Systems in Predicting Outcomes of Diabetic Foot Ulcers: A Prospective Observational Study

Abstract

Background & Objectives: Diabetic foot ulcers are a major complication of diabetes mellitus and are associated with infection, neuropathy, peripheral arterial disease, amputation and mortality. Appropriate classification is important for assessment of severity and prediction of outcome. This study compared the Wagner and University of Texas (UT) diabetic foot ulcer classification systems and evaluated their association with healing and adverse outcomes. Methods: A prospective observational study was conducted among 100 consecutive patients with diabetic foot ulcers presenting to a tertiary care hospital. Demographic characteristics, duration of diabetes, ulcer characteristics, infection, osteomyelitis, neuropathy and peripheral arterial disease were recorded. Each ulcer was classified using the Wagner and UT systems. Patients were followed until complete healing, amputation or death. Statistical analysis was performed using IBM SPSS Statistics version 20.0. Categorical variables were analysed using the chi-square test or Fisher's exact test, and continuous variables using the independent-samples t-test. A P value <0.05 was considered statistically significant. Results: The mean age was 59 ± 8.12 years and 82% were male. Wagner grades I–V accounted for 13%, 36%, 32%, 15% and 4%, respectively. UT grades 1–3 accounted for 13%, 35% and 52%, while stages A–D accounted for 10%, 12%, 14% and 64%, respectively. Complete healing occurred in 34 patients, 60 underwent amputation, and 6 died. Thus, 66 patients had a combined adverse outcome. Increasing UT grade and stage were significantly associated with adverse outcomes (P<0.001). Healing occurred in 92.3%, 45.7% and 11.5% of patients with UT grades 1, 2 and 3, respectively. Healing occurred in 100%, 75%, 35.7%, and 15.6% of patients with UT stages A, B, C and D, respectively. Interpretation & Conclusions: Both Wagner and UT classifications demonstrated an association with diabetic foot severity and outcome. The UT system, by incorporating infection and ischemia in addition to ulcer depth, provided more detailed prognostic stratification. Higher UT grade and stage were strongly associated with failure to heal and adverse outcomes.