Epidemiology of limb loss and congenital limb deficiency: a review of the literature.
OBJECTIVE
To examine the state of research on population-based studies of the incidence of limb amputation and birth prevalence of limb deficiency.


METHODS
A total of 18 publication databases were searched, including MEDLINE, CINAHL, and the Cochrane Library.


METHODS
The search was performed by using a hierarchical process. Articles were reviewed for inclusion by 3 reviewers. Inclusion criteria included defined catchment area, calculation of population-based incidence rates, defined etiology of limb loss, and English language. Review articles, animal studies, case reports, cohort studies, letters, and editorials were excluded.


METHODS
Figures on the estimated incidence of amputation and birth prevalence of congenital limb deficiency were gleaned from selected reports and assembled into a table format by etiology.


RESULTS
The studies varied in scope, quality, and methodology, making comparisons between studies difficult. Incidence rates of acquired amputation varied greatly between and within nations. Rates of all-cause acquired amputation ranged from 1.2 first major amputations per 10,000 women in Japan to 4.4 per 10,000 men in the Navajo Nation in the United States between 1992 and 1997. Consistent among all nations, the risk of amputation was greatest among persons with diabetes mellitus.


CONCLUSIONS
Surveillance of congenital limb deficiency exists in much of the developed world. Existing studies of acquired amputation suffer from a host of methodologic problems. Future efforts should be directed toward the application of standardized measures and methods to enable trends to be evaluated over time and comparisons to be made within and between countries.
Center for Injury Research and Policy, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. pephraim@jhsph.edu
Patti L
PL
Ephraim
Timothy R
TR
Dillingham
Mathilde
M
Sector
Liliana E
LE
Pezzin
Ellen J
EJ
Mackenzie
D017677:Age Distribution; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D001723:Birth Rate; D017719:Diabetic Foot / Q000453:epidemiology / Q000601:surgery; D005121:Extremities / Q000293:injuries / Q000601:surgery*; D014943:Global Health; D006801:Humans; D015994:Incidence; D017880:Limb Deformities, Congenital / Q000453:epidemiology*; D009369:Neoplasms / Q000453:epidemiology / Q000601:surgery; D016491:Peripheral Vascular Diseases / Q000453:epidemiology / Q000601:surgery; D011159:Population Surveillance; D015995:Prevalence; D012107:Research Design / Q000592:standards; D012189:Retrospective Studies; D012307:Risk Factors; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery