Waiting for the Referral: Diagnostic Delay in Diabetes-Related Foot Ulceration and What It Costs the Limb
DOI:
https://doi.org/10.5281/zenodo.22238741Keywords:
Diabetic foot ulcer, Referral delay, Fast-track pathway, Amputation, Primary careAbstract
A foot ulcer in a person with diabetes deteriorates on a timescale measured in days, and the interval before it reaches a specialist
team is measured in weeks to months. Surveys across Europe report that the duration of the ulcer was unknown or the diagnosis
delayed beyond three weeks in 55 to 66 per cent of cases, and that on average 48 per cent of patients reached a specialist unit
either after an unknown interval or more than a month from onset. Against that background a fast-track pathway was developed,
defining referral windows by ulcer severity: within 24 hours for abscess, wet gangrene or fever, within four days for ischaemic,
deep or mildly infected ulcers, and within two weeks for uncomplicated non-healing ulcers. In a series of 200 patients assessed
against those thresholds, referral inside the window was associated with healing in 89.9 against 41.5 per cent, healing in 10
against 16 weeks, minor amputation in 17.6 against 75.6 per cent, major amputation in 0.6 against 36.6 per cent, admission in
47.1 against 82.9 per cent and death in 4.4 against 19.5 per cent. This review sets out where the interval accrues, why primary
care is poorly placed to close it, and why effect sizes of that magnitude should be read with care rather than quoted at face value.
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