Evaluation of diabetic wound classifications and a new wound score.

We review seven classification systems for foot wounds in patients with diabetes and evaluate them in a table format based on 10 criteria judged to be the most important for assessing their effectiveness. Criteria include such factors as objectivity, versatility, ability to measure progress, validity and reliability, and five other grading parameters. Concomitantly, the Wound Score, a paradigm for evaluating the problem wound, is described in detail and evaluated on the same ten criteria. Five assessments including appearance of the wound base, size, depth, bio-burden, and perfusion are each graded on a 0 to 2 scale and summated to generate the Wound Score. From the score three levels of seriousness become apparent: "healthy wounds" with scores of 8 to 10, "problem wounds" with scores of 4 to 7 and "futile wounds" with scores of 0 to 3. Because of its simplicity, user friendliness, ability to integrate wound and patient information, and design to reflect progress, the Wound Score scored better on the 10 evaluation criteria than any other foot wound evaluation system for patients with diabetes. The objectivity of grading the five assessments used to generate the Wound Score make this scoring system ideal for evaluating treatment interventions and outcomes of wounds of equal seriousness.