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Diabetes is a significant cause of mortality and morbidity throughout the world, particularly in low- and middle- income countries (LMICs). Uncontrolled diabetes can lead to a myriad of conditions, including diabetic neuropathy. A common consequence of neuropathy, coupled with poor vascular circulation is diabetic foot infection (DFI). The Wagner Score (WS) is a validated tool used to assess severity of diabetic foot ulcers. Its use has been studied in high income countries and suburban teaching hospitals in affluent regions. In LMICs, where advanced diagnostic modalities are often scarce, WS could serve as a low-cost and rapid tool to prognosticate and predict clinical outcome for patients presenting with DFI. In this study, we perform a retrospective chart review of 77 patients admitted to a county hospital in El Petén, Guatemala. Patients were predominantly men (79.2%) between 61 – 70 years old. Ulcers were the most common presentation, and WS IV (out of V) the most frequent classification. Age, surgical intervention, and edema were positively correlated with increasing WS, while hematocrit and debridement/lavage were negatively correlated. Our results suggest that WS is an effective, low-cost, and rapid tool for predicting likelihood of surgical intervention in a previously untested setting. This information is critical for improving care of patients with diabetes in LMICs throughout the world.
Popokh et al. (Wed,) studied this question.