Development of a prediction model for foot ulcer recurrence in people with diabetes using easy-to-obtain clinical variables
Introduction We aimed to develop a prediction model for foot ulcer recurrence in people with diabetes using easy-to-obtain clinical variables and to validate its predictive performance in order to help risk assessment in this high-risk group.Research design and methods We used data from a prospectiv...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e002257.full |
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| author | Ameen Abu-Hanna Wouter B aan de Stegge Martijn C Schut Jeff G van Baal Jaap J van Netten Sicco A Bus |
| author_facet | Ameen Abu-Hanna Wouter B aan de Stegge Martijn C Schut Jeff G van Baal Jaap J van Netten Sicco A Bus |
| author_sort | Ameen Abu-Hanna |
| collection | DOAJ |
| description | Introduction We aimed to develop a prediction model for foot ulcer recurrence in people with diabetes using easy-to-obtain clinical variables and to validate its predictive performance in order to help risk assessment in this high-risk group.Research design and methods We used data from a prospective analysis of 304 people with foot ulcer history who had 18-month follow-up for ulcer outcome. Demographic, disease-related and organization-of-care variables were included as potential predictors. Two logistic regression prediction models were created: model 1 for all recurrent foot ulcers (n=126 events) and model 2 for recurrent plantar foot ulcers (n=70 events). We used 10-fold cross-validation, each including five multiple imputation sets for internal validation. Performance was assessed in terms of discrimination using area under the receiver operating characteristic curve (AUC) (0–1, 1=perfect discrimination), and calibration with the Brier Score (0–1, 0=complete concordance predicted vs observed values) and calibration graphs.Results Predictors in model 1 were: a younger age, more severe peripheral sensory neuropathy, fewer months since healing of previous ulcer, presence of a minor lesion, use of a walking aid and not monitoring foot temperatures at home. Mean AUC for model 1 was 0.69 (2SD 0.040) and mean Brier Score was 0.22 (2SD 0.011). Predictors in model 2 were: a younger age, plantar location of previous ulcer, fewer months since healing of previous ulcer, presence of a minor lesion, consumption of alcohol, use of a walking aid, and foot care received in a university medical center. Mean AUC for model 2 was 0.66 (2SD 0.023) and mean Brier Score was 0.16 (2SD 0.0048).Conclusions These internally validated prediction models predict with reasonable to good calibration and fair discrimination who is at highest risk of ulcer recurrence. The people at highest risk should be monitored more carefully and treated more intensively than others.Trial registration number NTR5403. |
| format | Article |
| id | doaj-art-cbc526c8c1ed47898a537078b693f4d1 |
| institution | Kabale University |
| issn | 2052-4897 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-cbc526c8c1ed47898a537078b693f4d12024-12-12T13:30:09ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2021-002257Development of a prediction model for foot ulcer recurrence in people with diabetes using easy-to-obtain clinical variablesAmeen Abu-Hanna0Wouter B aan de Stegge1Martijn C Schut2Jeff G van Baal3Jaap J van Netten4Sicco A Bus5Amsterdam UMC, Department of Medical Informatics, University of Amsterdam, Amsterdam, The NetherlandsRehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The NetherlandsAmsterdam UMC, Department of Medical Informatics, University of Amsterdam, Amsterdam, The NetherlandsDepartment of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo, The NetherlandsRehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The NetherlandsDepartment of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, The NetherlandsIntroduction We aimed to develop a prediction model for foot ulcer recurrence in people with diabetes using easy-to-obtain clinical variables and to validate its predictive performance in order to help risk assessment in this high-risk group.Research design and methods We used data from a prospective analysis of 304 people with foot ulcer history who had 18-month follow-up for ulcer outcome. Demographic, disease-related and organization-of-care variables were included as potential predictors. Two logistic regression prediction models were created: model 1 for all recurrent foot ulcers (n=126 events) and model 2 for recurrent plantar foot ulcers (n=70 events). We used 10-fold cross-validation, each including five multiple imputation sets for internal validation. Performance was assessed in terms of discrimination using area under the receiver operating characteristic curve (AUC) (0–1, 1=perfect discrimination), and calibration with the Brier Score (0–1, 0=complete concordance predicted vs observed values) and calibration graphs.Results Predictors in model 1 were: a younger age, more severe peripheral sensory neuropathy, fewer months since healing of previous ulcer, presence of a minor lesion, use of a walking aid and not monitoring foot temperatures at home. Mean AUC for model 1 was 0.69 (2SD 0.040) and mean Brier Score was 0.22 (2SD 0.011). Predictors in model 2 were: a younger age, plantar location of previous ulcer, fewer months since healing of previous ulcer, presence of a minor lesion, consumption of alcohol, use of a walking aid, and foot care received in a university medical center. Mean AUC for model 2 was 0.66 (2SD 0.023) and mean Brier Score was 0.16 (2SD 0.0048).Conclusions These internally validated prediction models predict with reasonable to good calibration and fair discrimination who is at highest risk of ulcer recurrence. The people at highest risk should be monitored more carefully and treated more intensively than others.Trial registration number NTR5403.https://drc.bmj.com/content/9/1/e002257.full |
| spellingShingle | Ameen Abu-Hanna Wouter B aan de Stegge Martijn C Schut Jeff G van Baal Jaap J van Netten Sicco A Bus Development of a prediction model for foot ulcer recurrence in people with diabetes using easy-to-obtain clinical variables BMJ Open Diabetes Research & Care |
| title | Development of a prediction model for foot ulcer recurrence in people with diabetes using easy-to-obtain clinical variables |
| title_full | Development of a prediction model for foot ulcer recurrence in people with diabetes using easy-to-obtain clinical variables |
| title_fullStr | Development of a prediction model for foot ulcer recurrence in people with diabetes using easy-to-obtain clinical variables |
| title_full_unstemmed | Development of a prediction model for foot ulcer recurrence in people with diabetes using easy-to-obtain clinical variables |
| title_short | Development of a prediction model for foot ulcer recurrence in people with diabetes using easy-to-obtain clinical variables |
| title_sort | development of a prediction model for foot ulcer recurrence in people with diabetes using easy to obtain clinical variables |
| url | https://drc.bmj.com/content/9/1/e002257.full |
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