Predictive performance of the Saint Elian Wound Score System adjusted for age for major amputation in diabetic foot: A competing risks analysis

Aims To evaluate the prognostic performance of Saint Elian Wound Score System (SEWSS) adjusted for age in predicting major amputation (MA) in patients with diabetic foot (DF). Methods A retrospective cohort study was conducted, including 406 patients with DF treated at a hospital in Argentina in 2025. The primary outcome was MA, with wound healing and death considered competing events. A Fine and Gray model was used to assess the association between SEWSS and MA, adjusted for age. Model performance was evaluated in terms of discrimination, calibration and global precision. Internal validation was performed using bootstrap resampling. Sensitivity analyses were conducted to assess the impact of early loss to follow‐up. Results During follow‐up, 14.3% of patients underwent MA, 57.1% achieved wound healing and 3.5% died. In the competing risks model, each one‐point increase in the SEWSS was associated with a 41% increase in the subdistribution hazard of MA (sHR 1.41; 95% CI 1.31–1.51; p < 0.001), adjusted for age. The model demonstrated a 180‐day good discriminative ability, with a bootstrap‐corrected AUC of 0.848 and a Brier score of 0.097. Calibration was adequate in low and intermediate‐risk ranges. Conclusions The SEWSS, when adjusted for age and analysed using a competing risks framework, shows good prognostic performance for predicting MA in patients with DF. The model may support risk stratification and clinical decision‐making, although external validation in independent populations is required.