title: A systematic review and meta-analysis of tests to predict wound healing in diabetic foot.
abstract: BACKGROUND
  This systematic review summarized the evidence on noninvasive screening tests for the prediction of wound healing and the risk of amputation in diabetic foot ulcers.
  
  
  METHODS
  We searched MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Scopus from database inception to October 2011. We pooled sensitivity, specificity, and diagnostic odds ratio (DOR) and compared test performance.
  
  
  RESULTS
  Thirty-seven studies met the inclusion criteria. Eight tests were used to predict wound healing in this setting, including ankle-brachial index (ABI), ankle peak systolic velocity, transcutaneous oxygen measurement (TcPo2), toe-brachial index, toe systolic blood pressure, microvascular oxygen saturation, skin perfusion pressure, and hyperspectral imaging. For the TcPo2 test, the pooled DOR was 15.81 (95% confidence interval [CI], 3.36-74.45) for wound healing and 4.14 (95% CI, 2.98-5.76) for the risk of amputation. ABI was also predictive but to a lesser degree of the risk of amputations (DOR, 2.89; 95% CI, 1.65-5.05) but not of wound healing (DOR, 1.02; 95% CI, 0.40-2.64). It was not feasible to perform meta-analysis comparing the remaining tests. The overall quality of evidence was limited by the risk of bias and imprecision (wide CIs due to small sample size).
  
  
  CONCLUSIONS
  Several tests may predict wound healing in the setting of diabetic foot ulcer; however, most of the available evidence evaluates only TcPo2 and ABI. The overall quality of the evidence is low, and further research is needed to provide higher quality comparative effectiveness evidence.
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Department of Internal Medicine, University of Missouri, Columbia, Mo.
authors.forename: Rim
authors.initials: R
authors.lastname: Hasan
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Department of Internal Medicine, University of Missouri, Columbia, Mo.
authors.forename: Belal
authors.initials: B
authors.lastname: Firwana
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn.
authors.forename: Tarig
authors.initials: T
authors.lastname: Elraiyah
authors.affiliation: Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tsapas
authors.affiliation: Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn.
authors.forename: Larry
authors.initials: L
authors.lastname: Prokop
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Arizona Health Sciences Center, Tucson, Ariz.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Mills
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn. Electronic address: murad.mohammad@mayo.edu.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000842:Ankle / Q000098:blood supply / Q000601:surgery; D055109:Ankle Brachial Index; D017719:Diabetic Foot / Q000503:physiopathology*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012867:Skin / Q000098:blood supply; D014034:Toes / Q000098:blood supply; D014945:Wound Healing / Q000502:physiology*
chemical_list: D010100:Oxygen