[abstract] THE WAGNER SCORE: A BOON OR A BANE

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[abstract] THE WAGNER SCORE: A BOON OR A BANE

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Title: [abstract] THE WAGNER SCORE: A BOON OR A BANE
Author: Strauss, MB; Aksenov, IV; Miller, SS; France, EV
Abstract: BACKGROUND: Most practitioners in the field of hyperbaric oxygen (HBO) medicine and wound care are aware of the Wagner Grading System (WGS) for foot ulcerations. However, not many are familiar with the source of the WGS and the possible negative ramification it has for HBO medicinMATERIALS AND METHODS: This presentation analyzes the WGS and discusses concerns about its applicability to wounds for which HBO is being considered.RESULTS: Wagner's foot wound classification was first published in the A.A.O.S. [American Academy of Orthopaedic Surgeons] Instructional Course Lectures in 1979. The use of the WGS is currently mandated by CMS/Medicare and other insurance agencies in order to determine eligibility to receive HBO in diabetic foot wounds. Concerns include: 1) Use of a different criterion for establishing each grade, 2) Absence of severity parameters for each criterion, 3) Decisions for management are almost entirely dependent on the "ischemic index," which is notoriously invalid for diabetics and is not used today, 4) Use of six different decision making/management algorithms, each with outcomes ranging from salvage to lower limb amputation, 5) Outcomes based only on healing of amputations that ranged from toes to above knee levels, 6) Absence of validity or reliability studies, 7) Limited only to foot wounds and 8) No provision to quantify progress of a healing wounCONCLUSIONS: Use of the WGS for making decisions to justify HBO as an adjunct for managing diabetic foot wound is a matter of concern. Use of this archaic system may become a liability and a reason diabetic foot wounds (Wagner grade 3 or higher) may be downgraded to an investigational use of HBO. A more objective approach is the measurement of juxta-wound hypoxia in problem wounds and confirming its resolution with HBO.
Description: Undersea and Hyperbaric Medical Society, Inc. (http://www.uhms.org )
URI: http://archive.rubicon-foundation.org/3726
Date: 2006

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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