Larry M Jones1, Rebecca Coffey2, Sorabh Khandelwal3, Said Atway4, Gayle Gordillo5, Claire Murphy6, Jody A Fries7, Kathleen Dungan8. 1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Electronic address: Larry.jones@osumc.edu. 2. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 3. Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 4. Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 5. Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 6. Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 7. Department of Rehabilitation Services - Acute Care, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 8. Department of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Abstract
INTRODUCTION: Diabetes mellitus affects 25.8 million Americans and is predicted to almost double by 2050. The presence of diabetes complicates hospital courses because of the microvascular complications associated with disease progression. Patients with diabetes represent 18.3% of annual burn admissions to our unit and 27% have burns to the feet. The purpose of this project was to develop an evidence-based guideline for care of the patient with diabetes and foot burns METHODS: A multidisciplinary group was charged with developing an evidence-based guideline for the treatment of foot burns in patients with diabetes. Evidence was evaluated in the areas of diabetes, burn care, hyperbaric medicine, care of diabetic foot wounds and physical therapy. After guideline development and approval, key aspects were incorporated into order sets. RESULTS: Key aspects of this guideline are the ability to identify patients with undiagnosed diabetes, assess diabetic control, optimize glycemic and metabolic control, optimize burn wound management, treat microvascular disease, and provide education and a discharge plan. Evaluated outcomes are glycemic control, length of stay, complication rates, amputation rates, infection rates and the use of hyperbaric oxygen. CONCLUSIONS: Best outcomes for this high risk population will be attainable with an evidence based guideline.
INTRODUCTION:Diabetes mellitus affects 25.8 million Americans and is predicted to almost double by 2050. The presence of diabetes complicates hospital courses because of the microvascular complications associated with disease progression. Patients with diabetes represent 18.3% of annual burn admissions to our unit and 27% have burns to the feet. The purpose of this project was to develop an evidence-based guideline for care of the patient with diabetes and foot burns METHODS: A multidisciplinary group was charged with developing an evidence-based guideline for the treatment of foot burns in patients with diabetes. Evidence was evaluated in the areas of diabetes, burn care, hyperbaric medicine, care of diabetic foot wounds and physical therapy. After guideline development and approval, key aspects were incorporated into order sets. RESULTS: Key aspects of this guideline are the ability to identify patients with undiagnosed diabetes, assess diabetic control, optimize glycemic and metabolic control, optimize burn wound management, treat microvascular disease, and provide education and a discharge plan. Evaluated outcomes are glycemic control, length of stay, complication rates, amputation rates, infection rates and the use of hyperbaric oxygen. CONCLUSIONS: Best outcomes for this high risk population will be attainable with an evidence based guideline.