The reliability of the Wagner Scale for evaluation the diabetic wounds: A literature review

Abstract

Background and aims: Classification of wound severity is important in medical care decisions specially in diabetic patients. The Wagner Scale provides a structure to determine the severity of a wound by examining its depth and extent. The adequate reliability of this instrument, like other instruments for measuring health status, is important. So, the aim of this review is to report evidence on the reliability of the Wagner scale.

Method: A comprehensive search was performed in databases. Observational studies that assessed the reliability of the Wagner scale, with statistical measures, were included. Methodological quality of studies was evaluated with the COSMIN checklist. Finally, we report the reliability measurements, narratively.

Results: We assessed 7 studies. In all studies 1873 subjects participated. Methodological quality was good only in one study. In two studies used of weighted kappa (Inter Observer Reliability) that reliability was in median level in both studies. The relation between Wagner score and amputation were report in two studies that measured by X²_trend and regression analysis. In four measurements, reported the correlation between Wagner with ulcer healing by X²_trend, Log Rank, Kaplan-Meier, and inter quartile range.

Conclusion: It can be confirmed that the reliability of the Wagner scale is appropriate and this tool is recommended to evaluate the severity of the wounds specially in diabetic patients. It should also be noted that the user of the scale must be trained. In future studies, it is recommended to use appropriate methodology and complete reports for the reliability of Wagner scale.

Keywords: Diabetes; Foot ulcer; Ulcer; Wagner scale; Wound.