A Classification of Diabetic Foot Infections Using ICD-9-CM Codes: Application to a Large Computerized Medical Database


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dc.contributor.author Fincke, Benjamin G en_US
dc.contributor.author Miller, Donald R en_US
dc.contributor.author Turpin, Robin en_US
dc.date.accessioned 2011-12-29T23:07:47Z
dc.date.available 2011-12-29T23:07:47Z
dc.date.copyright 2010 en_US
dc.date.issued 2010-7-6 en_US
dc.identifier.citation Fincke, Benjamin G, Donald R Miller, Robin Turpin. "A classification of diabetic foot infections using ICD-9-CM codes: application to a large computerized medical database." BMC Health Services Research 10:192. (2010) en_US
dc.identifier.issn 1472-6963 en_US
dc.identifier.uri http://hdl.handle.net/2144/2634
dc.description.abstract BACKGROUND: Diabetic foot infections are common, serious, and varied. Diagnostic and treatment strategies are correspondingly diverse. It is unclear how patients are managed in actual practice and how outcomes might be improved. Clarification will require study of large numbers of patients, such as are available in medical databases. We have developed and evaluated a system for identifying and classifying diabetic foot infections that can be used for this purpose. METHODS: We used the (VA) Diabetes Epidemiology Cohorts (DEpiC) database to conduct a retrospective observational study of patients with diabetic foot infections. DEpiC contains computerized VA and Medicare patient-level data for patients with diabetes since 1998. We determined which ICD-9-CM codes served to identify patients with different types of diabetic foot infections and ranked them in declining order of severity: Gangrene, Osteomyelitis, Ulcer, Foot cellulitis/abscess, Toe cellulitis/abscess, Paronychia. We evaluated our classification by examining its relationship to patient characteristics, diagnostic procedures, treatments given, and medical outcomes. RESULTS: There were 61,007 patients with foot infections, of which 42,063 were classifiable into one of our predefined groups. The different types of infection were related to expected patient characteristics, diagnostic procedures, treatments, and outcomes. Our severity ranking showed a monotonic relationship to hospital length of stay, amputation rate, transition to long-term care, and mortality. CONCLUSIONS: We have developed a classification system for patients with diabetic foot infections that is expressly designed for use with large, computerized, ICD-9-CM coded administrative medical databases. It provides a framework that can be used to conduct observational studies of large numbers of patients in order to examine treatment variation and patient outcomes, including the effect of new management strategies, implementation of practice guidelines, and quality improvement initiatives. en_US
dc.description.sponsorship Merck and Company en_US
dc.language.iso en en_US
dc.publisher BioMed Central en_US
dc.rights Copyright 2010 Fincke et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. en_US
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_US
dc.title A Classification of Diabetic Foot Infections Using ICD-9-CM Codes: Application to a Large Computerized Medical Database en_US
dc.type article en_US
dc.identifier.doi 10.1186/1472-6963-10-192 en_US
dc.identifier.pubmedid 20604921 en_US
dc.identifier.pmcid 2914721 en_US

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