REPLY
Risk Factors for Amputation in Diabetics
Gayle E. Reiber and
Thomas D. Koepsell
1 February 1993 | Volume 118 Issue 3 | Page 231
IN RESPONSE:
Our inclusion criterion was an "initial amputation of the affected lower extremity" [1]. We did not study the preamputation treatment strategy and factors leading to the decision to amputate. We did, however, address many health care provider and patient risk factors where intervention could minimize the risk for limb loss.
As for infection in the cases and controls, including osteomyelitis, 68% of cases had an active infection of the affected lower extremity [1]. Infection was dichotomized as present or absent, based on physical examination, microbiologic culture results, radiologic studies, and pathology reports. The criteria for control selection excluded persons with chronic lower-extremity ulcers of over 4 weeks duration. Chronic ulceration usually precedes infection, and infection is unlikely without cutaneous involvement. Of 236 controls, 22 had a superficial cut or scratch of less than 4 weeks duration, and 1 had a resolving superficial infection. Thus, controls had no lower-extremity ulcers or serious infections (including osteomyelitis).
1. Reiber GE, Pecoraro RE, Koepsell TD. Risk factors for amputation in patients with diabetes mellitus: a case–control study. Ann Intern Med. 1992; 117:97-105.
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