Haverkes, L. (2012) Diagnostiek voorafgaande aan beenamputaties bij patiënten met diabetes mellitus. thesis, Medicine.
Full text available on request.Abstract
Introduction: Even though several studies on the treatment of the diabetic foot have been conducted, little is known about performance of the diagnostics in the period before treatment. The recently revised guidelines state that proper diagnostics are essential for optimal treatment. Aim of this study is to gain insight in the extent with which diagnostics are performed in accordance with the guidelines. Methods: Diagnostics performed in patients with diabetes mellitus who underwent an lower-extremity amputation in the period 2007-2011 were retrospectively examined. ‘Complete diagnostics’ were determined based on the guidelines. Distinction was made between non-invasive and invasive diagnostics focused on chronic ischaemia and diagnostics focused on infection. Performed diagnostics were compared with diagnostics according to the guidelines. Results: The study group included 122 lower-extremity amputations. Non-invasive diagnostics were complete in 66% of the cases, invasive diagnostics in 49%. The largest loss was seen in lack of visualisation of the distal arteries. Diagnostics focused on infection were complete in 27% of the cases. In the group ‘combination of chronic ischaemia and infection’ more diagnostics focused on ischaemia were performed than in patients with chronic ischaemia alone (e.g. angiography with visualisation of distal arteries: 52% vs 30%), but significant less diagnostics focused on infection were performed than in patients with infection alone (e.g. wound culture: 55% vs 93%, p=0.007). Conclusion: Diagnostics is often not performed in accordance with the international guidelines. The largest loss is seen in lack of visualisation of the distal arteries. When a combination of chronic ischaemia and infection is present, more diagnostics are performed focused on ischaemia, whereas less diagnostics are performed focused on infection. Improving implementation and compliance to protocols based on the guidelines is recommended.
| Item Type: | Thesis (Thesis) |
|---|---|
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:04 |
| Last Modified: | 25 Jun 2020 11:04 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2379 |
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