Diabetic Ulcer Severity Score

NewsBot · Dec 29, 2016

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Validation of Diabetic Ulcer Severity Score (DUSS).
Shashikala C.K. et al
Annals of International Medical and Dental Research, Vol (3), Issue (1)

Background: A number of foot ulcer classification systems have been devised in an attempt to categorize ulcers more
effectively and allow effective comparison of the outcome of routine management. DUSS (Diabetic Ulcer Severity Score) is
one of the latest wound based system of classification, which needs to be validated. Aims and Objectives: Our aim was
validation of this diabetic ulcer severity score (DUSS), with patients outcome including healing and amputation. Methods:
Total of 100 Diabetic patients attending surgical outpatient clinic or admitted into the hospital (BMCRI) with diabetic foot
ulcers from September 2014 to September 2016 were included in the study. Necessary data was collected .DUSS score
was calculated for each patient and analysis was done using SPSS package version16. Results: Most common age group
affected with Diabetic foot was between 41 -60 years. Males were commonly affected by Diabetic foot ulcers accounting to
68% .Most commonly ulcers were of DUSS Score of 2 followed by Score 3. Overall 50 (50.0%) of 100 people had
amputations in our study. Major Amputation was done for 25% of patients. Minor Amputation was done in 25% of patients
in our study. The probability of healing with score 0 was 95%,91.6% with score 1,85.7% with score 2,52% with score 3, and
28.5% with score 4. Conclusion: DUSS scoring system provides an easy diagnostic tool for predicting probability of
healing or amputation .This is a very simple and easy scoring system which needs no advanced investigation tool and can
be easily followed even in busy OPD
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NewsBot · Oct 5, 2021

Efficacy of diabetic ulcer severity score in patients with diabetic foot
ulcer in predicting prognosis
Robinson George, Joe Mathew, Vishnu M. L., Jacob P. Thomas
Int Surg J. 2021 Oct;8(10):2961-2967

Background: Diabetic foot ulcer (DFU) is a full-thickness wound, skin necrosis or gangrene below the ankle induced
by peripheral neuropathy or peripheral arterial disease in patients with diabetes. There are well-accepted classification
systems for DFUs, namely Wagner’s scoring system, university of Texas scoring system etc. However, only few are
scientifically validated. Diabetic ulcer severity score (DUSS) introduced by Beckert et al consists of easily accessible
clinical parameters which categorizes wounds into specific subgroups for comparison of outcomes.
Methods: A prospective study was conducted on 250 diabetic ulcer patients, attending the out-patient department
(OPD) of surgery, Pushpagiri institute of medical sciences, Tiruvalla.
Results: Most common age group affected with diabetic foot was between 51-60 years (mean 58.9±10.2 years).
Males accounted for 54% of patients. Most common ulcers were of score of 2 followed by score 3. Overall, 105
(42%) of 250 people had amputations in our study with majority undergoing minor amputation (30%) than the major
amputation (12%). None of the patients with scores 0, 1 and 2 had major amputation. Probability of healing among
the various scores were-100% for score 0, 97.9% for score 1, 83.4% for score 2, 17.7% for score 3 and 4.8% for score
4. Lower score is strongly associated with primary healing and higher score with amputations.
Conclusions: DUSS system is an easy wound based diagnostic tool for anticipating probability of healing or
amputation and need for surgery by assessing the four clinical parameters and combining them which is safe and
easily reproducible.
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NewsBot · Apr 20, 2023

A Study to Evaluate the Validity of Diabetic Ulcer Severity Score in Predicting Outcome of patients with Diabetic Foot Ulcer
M. Elanchezhian K. Kesavalingam
Journal of Medicine and Health Research, Page 24-28

Aim: To evaluate the validity of Diabetic Ulcer Severity Score in predicting the outcome of patients with Diabetic Foot Ulcer
Methods: The materials used in the study consisted of 150 patients with Diabetic Foot Ulcer were admitted in department of General Surgery in Government Mohan Kumaramangalam Medical College and Hospital, Salem during January 2021 and October 2022.
Results: Most of the diabetic ulcers were scored with DUSS Score of 2 and 1. Almost 80 out of 150 people had amputations in this study. Amputations were more common in patients with DUSS score 4 followed by 3. Major amputations were common in diabetic ulcers with DUSS score 4 and no patients with score 0 and 1 had major amputation. Minor amputations were more common in diabetic ulcers with DUSS score of 2. The probability of healing without amputation with score 0 was 100% and decreases to 17.3%% with score 3 and 0% with score 4.
Conclusion: DUSS scoring system delivers an easy diagnostic tool for assessing need for surgery and expectation of probability of healing/amputation by combining four clinically assessable wound based parameters. This is a simple and easy scoring system which does not need advanced investigations and can be easily followed.
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NewsBot · Jul 25, 2023

A study to correlate duss score with clinical outcome in patients of diabetic
foot ulcers
Ayushi Bhayal et al
Source

Introduction: Diabetic foot ulcer has been defined as “an ulceration of the foot associated
with neuropathy and different grade of ischemia andinfection.”2
The condition is usually
secondary to diabetic neuropathy due to uncontrolled diabetes orpoorglycemic status. The site
of ulcers in diabetes are typically seen at the area of foot which encounters constant pressure
or repetitive trauma. We carried out this study to determine the utility of this scoring system
in predicting the clinical outcome of diabetic foot ulcer in routine clinical setting.
Materials and Methodology: This study was adopted as a clinical, prospective,
observational, cohort study which was carried out in Out-Patient Department as well as
Emergency Department at People’s college of Medical Sciences and Research Centre,
Bhopal. The duration of the study has been set up around 22 months from December 2020 to
September 2022. All the study participants were carefully selected based on the inclusion
criteria and Written consent was obtained from all the study participants after explaining
them nature and purpose of study.
Results: The association between DUSS score and primary healing showed that the primary
healing was significantly better in patients with low DUSS score (0,1) as compared to
patients with DUSS score of 2 or above (p<0.05). Table – 5 correlated the association
between DUSS score and plastic surgery. Therefore the results showed that plastic surgery
was done in significantly higher proportions of cases with DUSS score 2 (36.4%), followed
by 29% cases with DUSS score 3 (p<0.05). When DUSS score and minor amputation were
correlated, it has been tabulated that the rate of minor amputation is relatively be higher in
patients with DUSS score 3 and 4. The rate of toe amputation was higher in patients with
DUSS score 3 whereas the rate of fore foot amputation was higher inpatients with DUSS
score 4(p<0.05).
Conclusion: Advancing age, duration of diabetes and untreated/improper treatment of
diabetes mellitus are predictors of high DUSS score that is linked with poor clinical outcome
in terms of need of debridement, plastic surgery and amputation. Hence, DUSS score can be a
part of day-to-day practice in diabetic clinics to classify the ulcers early and plan the
management of patients according to the predicted clinical outcome.
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NewsBot · Oct 27, 2024

Role of Diabetic Ulcer Severity Score (DUSS) in Predicting Outcome in Diabetic Foot Ulcers
Prashant Yadahalli, Ramesh Singaraddi and Vikram Nagathan
Source

DUSS (Diabetic Ulcer Severity Score) is one of the latest wound based system of classification which needs to be validated. This diabetic ulcer severity score (DUSS) designed by Becker in 2006, defines four clinical parameters, namely palpable pedal pulses, probing to bone, ulcer location and presence of multiple ulcerations. It is a simple and easily reproducible scoring system. A total of 82 diabetic patients with diabetic foot ulcers irrespective of the duration, attending surgical outpatient clinic or admitted to the hospital were studied based on the inclusion and exclusion criteria mentioned previously. The baseline demographic data which includes age, sex, occupation, educational qualifications, habits (smoking/consumption of alcohol) and socioeconomic status were recorded. At the time of follow up after 6 months, in all the patients with DUSS score 0 ulcers were healed completely. Among patients with DUSS 1, 87.2% of ulcers were healed completely where as 12.3% of ulcers were not healed. Among patients with DUSS score 2, 57.1% of ulcers were healed completely where as 42.9% of ulcers were not healed. Among patients with DUSS score 3, 11.1% of ulcers were healed completely where as 44.4% of ulcers were not healed and 44.4% of ulcers required amputation.
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NewsBot · Jun 1, 2025

Factors influencing the severity of diabetic foot ulcers: a cross-sectional study
Rickson Bahati, Daniel Kitua, Leonard Selestine, Ally Mwanga, Miriam Urio, Godfrey Mchele & David Antanamsu
BMC Endocrine Disorders volume 25, Article number: 76 (2025)

Background

Diabetic foot ulcers (DFUs) are prevalent among individuals with poorly controlled diabetes, and severe cases can result in increased morbidity and a poor quality of life. This study aimed to identify the factors that affect the severity of DFUs, offering insights into potential interventions that could enhance patient outcomes.
Methodology

A prospective cross-sectional study was conducted from August 2023 to March 2024 at Muhimbili National Hospital in Tanzania, involving 177 consecutively selected patients with DFUs. The primary outcome variable was the severity of DFUs, which was assessed using the Meggitt-Wagner severity score. Both socio-demographic and clinical characteristics were evaluated to determine their association with the outcome variable using multivariate ordinal logistic regression analysis.
Results

The median age of the study participants was 60 years (IQR = 52–68), with a male-to-female ratio of 2 to 1. Notably, Wagner grades 4 and 5 accounted for 57.6% of the participants. Factors associated with increased severity of DFUs included age over 60 years (aOR = 1.83, 95% CI 1.05–3.23, p = 0.035) and poor adherence to diabetes medications (aOR = 2.62, 95% CI 1.36–5.09, p = 0.004). Conversely, having health insurance coverage was linked to better outcomes (aOR = 0.51, 95% CI 0.27–0.96, p = 0.036).
Conclusion

The study highlights factors that can enhance comprehensive care for diabetic patients, especially elderly individuals. Key measures include implementing educational programs to encourage medication adherence, improving healthcare access, particularly for uninsured individuals, promoting insurance coverage, and making diabetes treatments more affordable.
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NewsBot · Sep 12, 2025

A Prospective Observational Study on the Clinical Outcomes of Diabetic Foot Ulcers Based on Diabetic Ulcer Severity Score at a Tertiary Care Center in Jharkhand, India
Krishna Murari et al
Cureus. 2025 Aug 6;17(8):e89523

Background People with long-standing or poorly controlled diabetes often experience problems in their feet due to nerve damage and poor blood circulation. These issues can make the feet more prone to injury and infection. When wounds do occur, they may not heal properly, sometimes resulting in ulcers, which may even lead to amputations of the foot if not managed properly and timely. This is a serious complication of diabetes. In order to manage the ulcers efficiently, a scoring system can be used to assess the severity and guide the treatment modality accordingly. Methods This was a prospective, observational study, conducted at the Department of General Surgery of the Rajendra Institute of Medical Sciences (RIMS), Ranchi, over a period of six months. A total of 150 patients who were diagnosed with diabetic foot ulcers (DFUs) were recruited for the study using a consecutive sampling method. Data collection was done using a pre-tested questionnaire to collect demographic information, medical history, and ulcer characteristics. A clinical examination was done, and the Diabetic Ulcer Severity Score (DUSS) scoring system was used to assess the severity of ulcers based on pedal pulse, bone exposure, ulcer location, and number of ulcers. Data were analysed using IBM SPSS Statistics software (Version 26, IBM Corp., Armonk, NY) with descriptive statistics and chi-square tests. A p-value of less than 0.05 was considered statistically significant. Ethical approval was taken from the Institutional Ethics Committee of RIMS. Results The study included 78 male (52.0%) and 72 female patients (48.0%), with most participants (39.3%) falling in the 46-60 years age group. A significant proportion (57.3%) hailed from rural areas, and 46% had a diabetes duration exceeding 10 years. Ulcer characteristics revealed that 48% were deep, 51.4% had mild infection, and 42% exhibited mild ischemia. The DUSS score analysis revealed that 36% of patients had a score of two, while 33.3% had a score of one. Amputation was the most common treatment outcome, seen in 59% of cases, followed by surgical debridement in 36%. There was a statistically significant association between higher DUSS scores and both longer hospital stays (χ²=64.9, p<0.00001) and a greater likelihood of amputation (χ²=36.9, p<0.00001). Importantly, all patients with DUSS scores of three or four required amputation. Conclusion The findings unequivocally demonstrate that higher DUSS scores are strongly associated with adverse clinical outcomes, specifically prolonged hospital stays and increased rates of lower limb amputation. The DUSS proves to be a good prognostic tool for early risk stratification, guiding timely and appropriate therapeutic interventions, but there is a need for clinical judgement and other imaging modalities for better patient care alongside the tool. The study underscores the need for early identification and aggressive management of DFUs, particularly in high-risk populations, and at lower levels of healthcare to improve patient outcomes and alleviate the burden on higher centers.
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NewsBot · Sep 28, 2025

The Association of Wagner Classification, Microbial Resistance, Immune Markers, and Glycemic Control With Diabetic Foot Ulcer Severity: A Multi-disciplinary Approach to Predict Severity and Outcome
Muhammad Numan Saleem et al
Cureus. 2025 Aug 24;17(8):e90914.

Background: Leukocytes play a crucial role in immune function, and inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are emerging as important predictors of diabetic foot ulcer (DFU) severity, infection risk, and healing outcomes. These markers may aid in early detection and improved prognosis. This study aims to evaluate the predictive value of inflammatory markers (NLR, PLR, MLR, total leukocyte count (TLC), absolute lymphocyte count (ALC)) in relation to DFU severity, glycemic control, and healing outcomes.

Methodologies: A comparative cross-sectional study was conducted at the endocrinology Ward of Hayatabad Medical Complex (HMC), Peshawar. A total of 102 diabetic foot ulcer patients were included in the study. Patients' consent, demographic data, and clinical data were taken. Blood samples were collected for hematological, biochemical analysis, and wound culture samples for bacterial species identification and drug sensitivity. Data was collected and analyzed through SPSS 22 (IBM Corp., Armonk, NY, USA).

Results: A weak negative correlation was observed between ALC and Wagner grade (ρ = -0.134), which was not statistically significant. TLC also demonstrated a weak negative correlation with Wagner grade (ρ = -0.240), approaching but not reaching statistical significance. A weak positive correlation was found between TLC and hemoglobin A1C (HbA1C) (ρ = 0.199), which was statistically significant. In contrast, ALC showed no significant correlation with either HbA1c (ρ = -0.002) or fasting blood sugar (FBS) (ρ = -0.066). Statistically significant reductions were observed in FBS (p < 0.001), random blood sugar (p < 0.001), and TLC (p < 0.001) following treatment. Microbiological analysis of diabetic foot ulcers revealed a diverse range of bacterial isolates. The most frequently identified organism was Pseudomonas aeruginosa (13, 12.7%), followed by Escherichia coli (12, 11.8%) and Proteus species (11, 10.8%).

Conclusions: No significant association was observed between ALC and Wagner grade in this study. Further studies with larger sample sizes are needed to clarify this relationship. However, a positive correlation between TLC and glycemic control suggests that poor glycemic control can affect the immune system and decrease the healing process, which may result in increased hospital stays for patients or unhealed ulcers leading to amputation.
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Diabetic Ulcer Severity Score

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Diabetic Ulcer Severity Score

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Severity and duration of diabetic foot ulcer (DFU) before seeking care as predictors of healing time

Fibrinogen: A Marker in Predicting Diabetic Foot Ulcer Severity

Nutritional status deteriorates as the severity of diabetic foot ulcers increases

Gene associated with diabetic foot ulcer severity and surgical outcomes

Severity Score for Diabetic Foot Ulcers

Ethacridine for diabetic foot ulcers

Sitagliptin for Diabetic Foot Ulcers

Share This Page

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