Pie risk, una herramienta para la prevención del pie diabético
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Keywords

pie diabético
evaluación del riesgo
prevención primaria
enfermera entrenada
equipo de atención en salud
Diabetic Foot
Risk Assessment
Primary Prevention
Nurse Practitioners
Patient Care Team

How to Cite

Orduz, A., Tique, C., Stetphens, I., González, A., Noel, B., & Tamayo, D. (2017). Pie risk, una herramienta para la prevención del pie diabético. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 3(1), 25–34. https://doi.org/10.53853/encr.3.1.21

Abstract

Introducción: El pie diabético es un problema de salud pública debido a su elevada frecuencia, severidad y a su impacto económico. En la etapa prepatogénica, el pie presenta alteraciones funcionales y estructurales que de no detectarse a tiempo pueden progresar a la úlcera. Sin embargo, el examen de los pies no se realiza en la mayoría de las consultas. La prevención primaria y la detección oportuna deben tener lugar en el primer nivel de atención.
Objetivo: Desarrollar y validar un instrumento simple y práctico para clasificar de manera temprana el pie del paciente diabético en riesgo por parte de la enfermera entrenada antes de la visita a su médico tratante, teniendo en cuenta todos los elementos patogénicos.
Métodos: Estudio transversal. Se creó una escala a partir de la experiencia clínica en donde se califican ocho factores de riesgo para desarrollar ulceración: tiempo de diabetes desde el diagnóstico, control metabólico, presencia de síntomas de neuropatía diabética, diagnóstico de la neuropatía por monofi- lamento, presencia de claudicación intermitente y ausencia de pulsos periféricos, presencia de deformidades, presencia de infecciones locales e historia anterior de úlceras que sanaron, amputaciones menores o pie de Charcot. Los puntajes fueron asignados según gravedad. Esta herramienta fue aplicada a un grupo de 204 diabéticos con ulceración y 207 pacientes diabéticos sin ulceración.
Resultados: El promedio de edad fue de 65 años, el 42,8% de los pacientes eran hombres. La edad y todos los ítems de la escala, excepto hemoglobina glucosilada, fueron asociados con la presencia de úlcera. Usando un punto de corte de 10 puntos, la herramienta tuvo una sensibilidad del 100% y una especificidad del 73,4% para el diagnóstico de úlcera, con un área bajo la curva ROC de 0,992(IC 95%, 0,986 A 0,998).
Conclusión: La herramienta “pie risk” es útil para la calificación y valoración del riesgo de pie diabético.

Abstract
Background: The diabetic foot is a public health problem due to its frequency, severity and economic impact. In prepathogenic phases, the foot presents structural and functional alterations that, if not detected opportunely, will progress to an ulcer. However, a thorough examination of the diabetic patient’s feet is often eluded in routine health controls.
Objective: To develop and validate a simple and practical instrument for early classification of the diabetic foot risk that can be easily applied by a trained nurse before the medical visit.
Methods: Cross-sectional study. Based on clinical expertise, a scale with eight risk factors for foot ulcer was developed: time from diagnosis, glycosylated hemoglobin, neuropathy symptoms, monofilament test, absent pulses or claudication; deformities, local infection and history of either amputation, ulceration or Charcot foot. Item scores were assigned based on severity. The tool was tested in a group of 204 ulcerated diabetic patients and 207 of non-ulcerated diabetic patients.
Results: Median age was 65 years, 42.8% of patients were male. Age and all scale items except glycosylated hemoglobin were statically associated with ulcer presence. Using the proposed cut point of 10 points, the scale has 100% sensitivity and73.4% specificity for ulcer diagnosis, with an area under the ROC curve of 0.992 (95% CI 0.986 to 0.998).
Conclusions: ‘Pie risk’ is a useful tool for the evaluation and risk assessment of the diabetic patient.

https://doi.org/10.53853/encr.3.1.21
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