Diagnostic accuracy of existing methods for identifying diabetic foot ulcers from inpatient and outpatient datasets

Min Woong Sohn, Elly Budiman-Mak, Rodney M. Stuck, Farah Siddiqui, Todd A. Lee

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Background: As the number of persons with diabetes is projected to double in the next 25 years in the US, an accurate method of identifying diabetic foot ulcers in population-based data sources are ever more important for disease surveillance and public health purposes. The objectives of this study are to evaluate the accuracy of existing methods and to propose a new method.Methods: Four existing methods were used to identify all patients diagnosed with a foot ulcer in a Department of Veterans Affairs (VA) hospital from the inpatient and outpatient datasets for 2003. Their electronic medical records were reviewed to verify whether the medical records positively indicate presence of a diabetic foot ulcer in diagnoses, medical assessments, or consults. For each method, five measures of accuracy and agreement were evaluated using data from medical records as the gold standard.Results: Our medical record reviews show that all methods had sensitivity > 92% but their specificity varied substantially between 74% and 91%. A method used in Harrington et al. (2004) was the most accurate with 94% sensitivity and 91% specificity and produced an annual prevalence of 3.3% among VA users with diabetes nationwide. A new and simpler method consisting of two codes (707.1× and 707.9) shows an equally good accuracy with 93% sensitivity and 91% specificity and 3.1% prevalence.Conclusions: Our results indicate that the Harrington and New methods are highly comparable and accurate. We recommend the Harrington method for its accuracy and the New method for its simplicity and comparable accuracy.

Original languageEnglish
Article number27
JournalJournal of Foot and Ankle Research
Issue number1
StatePublished - Nov 24 2010

Bibliographical note

Funding Information:
The authors gratefully acknowledge the financial support from the Center for Management of Complex Chronic Care, Hines VA Hospital, Hines, IL (LIP 42-522; Elly Budiman-Mak, MD, Principal Investigator). The paper presents the findings and conclusions of the authors; it does not necessarily represent the Department of Veterans Affairs or Health Services Research and Development Service. We are also grateful to Dr. Julia Riley for her initial work on chart reviews. The corresponding author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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