The SHID wound classification system for diabetic foot ulcer patients: a validity study

Abstract

This study aimed to evaluate the predictive validity of the SHID (Suriadi, Haryanto, Imran dan Defa) wound classification system compared to TU (Texas University) and Wagner wound classification systems in Indonesia. A prospective cohort study included patients with diabetic foot ulcers at Kitamura wound clinic in Indonesia. A total of 111 diabetic foot ulcer patients were assessed with SHID, TU, and Wagner wound classification systems. Two postgraduate nursing students assessed 111 wounds of bedside patients and observed them for 4 weeks. The predictive validity test indicated that the cut-off score of ≤grade 2 for SHID was 74% and 97%, ≤grade IB for TU was 77% and 92%, then ≤grade 2 for Wagner was 84% and 71% for sensitivity and specificity, respectively. The area under the curve (AUC) in SHID, TU, and Wagner tools was 0.90 (95% CI: 0.828-0.950), 0.85 (95% CI: I0.766-0.910), and 0.86 (95% CI: 0.775-0.917), respectively. The Youden index for SHID, TU, and Wagner was 0.72%, 0.70%, and 0.55%, respectively. The wound classification systems are good tools for identifying diabetic foot ulcers. However, the newly developed SHID tool produced the best AUC and Youden Index values compared to the Wagner tool.

Keywords: ABI – ankle brachial index; AUC – area under the curve; CI – confidence interval; DFU – diabetic foot ulcer; PEDIS – Perfusion, Extent, Depth, Infection, and Sensation; RN – registered nurse; ROC – receiver operating characteristic; SHID; SHID – Suriadi, Haryanto, Imran, Defa; SINBAD – Site, Ischemia, Neuropathy, Bacterial Infection and Depth; TU – Texas University; predictive validity; wound classification.