title: Identifying diabetic patients at high risk for lower-extremity amputation in a primary health care setting. A prospective evaluation of simple screening criteria.
abstract: OBJECTIVE
  To evaluate prospectively a risk categorization scheme for lower-extremity problems that incorporates the Semmes-Weinstein 5.07 monofilament and a simple exam to stratify patients who were followed in a primary-care setting into risk groups for plantar ulceration and lower-extremity amputation.
  
  
  METHODS
  Patients with diabetes in a well-defined American-Indian population were stratified into four risk categories based on sensation status to the 5.07 monofilament, the presence of foot deformity, and a history of lower-extremity events (amputation or ulceration): category 0, sensate; category 1, insensate; category 2, insensate with deformity; and category 3, history of lower extremity events. Patients were followed prospectively for lower extremity events and changes in sensation status.
  
  
  RESULTS
  We gave screening exams to 358 (88%) of 406 individuals with diabetes in the community. The distribution of patients for risk categories 0, 1, 2, and 3 was 74.3, 8.4, 4.5, and 13%, respectively. Over a 32-mo follow-up period, 41 patients developed ulcerations, and incidence rates correlated positively with increasing risk category (P less than 0.00001). All 14 amputations occurred in risk groups 2 and 3.
  
  
  CONCLUSIONS
  These data suggest that the risk categorization described here may have a role in identifying patients at risk for lower extremity events who are followed in a primary-care setting.
authors.affiliation: Bemidji Area Indian Health Service Diabetes Program, Minnesota 56601.
authors.forename: S J
authors.initials: SJ
authors.lastname: Rith-Najarian
authors.forename: T
authors.initials: T
authors.lastname: Stolusky
authors.forename: D M
authors.initials: DM
authors.lastname: Gohdes
mesh_terms: D000671:Amputation, Surgical; D003929:Diabetic Neuropathies / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D007198:Indians, North American; D007871:Leg Ulcer / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D008910:Minnesota; D011320:Primary Health Care; D012307:Risk Factors