title: The Incidence of Confounding Factors in Patients With Diabetes Mellitus Hospitalized for Diabetic Foot Ulcers.
abstract: BACKGROUND
  Uncontrolled deformity, deep infection, and/or ischemia-hypoxia are highly associated with healing challenges of diabetic foot ulcers (DFUs). This paper reports the occurrences of these factors that the authors label the "Troublesome Triad" (TT) in a prospective series of 62 patients with diabetes mellitus (DM), who were hospitalized because of their DFUs.
  
  
  METHODS
  With Institutional Review Board approval, the authors gathered data in a prospective series of patients hospitalized because of lower extremity wounds. From this data, they analyzed the DFU cohort for the incidence of each of the components of the TT. The severity of the wound was graded with the authors' 0 to 10 Wound Score in the patients who had components of the TT and compared with those who did not.
  
  
  RESULTS
  One or more components of the TT were observed in 57 patients (91.9%). As the number of confounders increased, mean Wound Scores decreased from 5.2 for 1 confounder to 2.9 for 3 confounders (P = 0.003). Most patients had 1 or 2 confounders (38.7% and 45.2%, respectively), while only 5 (8.1%) patients had all 3 confounders. Unresolved infection was the major confounder in 38 (61.3%) patients, uncontrolled deformity in 31 (50.0%), and ischemia-hypoxia in 26 (41.9%).
  
  
  CONCLUSIONS
  For those patients with DM who were hospitalized because of DFUs, confounders that require remedial interventions were present in more than 90% of patients. Recognition and management of the TT eliminates wasteful uses of resources in an attempt to heal lower extremity wounds in patients with DM where the confounders need to be addressed first.
authors: Long Beach Memorial Medical Center, Long Beach, CA.
authors: Michael B
authors: MB
authors: Strauss
authors: California State University, Long Beach, CA.
authors: Hojin
authors: H
authors: Moon
authors: Long Beach Memorial Medical Center, Long Beach, CA.
authors: Steven
authors: S
authors: La
authors: Long Beach Memorial Medical Center, Long Beach, CA.
authors: Alex
authors: A
authors: Craig
authors: Long Beach Memorial Medical Center, Long Beach, CA.
authors: Jose
authors: J
authors: Ponce
authors: Long Beach Memorial Medical Center, Long Beach, CA.
authors: Stuart
authors: S
authors: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D015986:Confounding Factors, Epidemiologic; D017719:Diabetic Foot / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D015994:Incidence; D023821:Limb Salvage / Q000379:methods*; D035002:Lower Extremity / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D014945:Wound Healing