Abstract
Background People with long-standing or poorly controlled diabetes often experience problems in their feet due to nerve damage and poor blood circulation. These issues can make the feet more prone to injury and infection. When wounds do occur, they may not heal properly, sometimes resulting in ulcers, which may even lead to amputations of the foot if not managed properly and timely. This is a serious complication of diabetes. In order to manage the ulcers efficiently, a scoring system can be used to assess the severity and guide the treatment modality accordingly. Methods This was a prospective, observational study, conducted at the Department of General Surgery of the Rajendra Institute of Medical Sciences (RIMS), Ranchi, over a period of six months. A total of 150 patients who were diagnosed with diabetic foot ulcers (DFUs) were recruited for the study using a consecutive sampling method. Data collection was done using a pre-tested questionnaire to collect demographic information, medical history, and ulcer characteristics. A clinical examination was done, and the Diabetic Ulcer Severity Score (DUSS) scoring system was used to assess the severity of ulcers based on pedal pulse, bone exposure, ulcer location, and number of ulcers. Data were analysed using IBM SPSS Statistics software (Version 26, IBM Corp., Armonk, NY) with descriptive statistics and chi-square tests. A p-value of less than 0.05 was considered statistically significant. Ethical approval was taken from the Institutional Ethics Committee of RIMS. Results The study included 78 male (52.0%) and 72 female patients (48.0%), with most participants (39.3%) falling in the 46-60 years age group. A significant proportion (57.3%) hailed from rural areas, and 46% had a diabetes duration exceeding 10 years. Ulcer characteristics revealed that 48% were deep, 51.4% had mild infection, and 42% exhibited mild ischemia. The DUSS score analysis revealed that 36% of patients had a score of two, while 33.3% had a score of one. Amputation was the most common treatment outcome, seen in 59% of cases, followed by surgical debridement in 36%. There was a statistically significant association between higher DUSS scores and both longer hospital stays (χ²=64.9, p<0.00001) and a greater likelihood of amputation (χ²=36.9, p<0.00001). Importantly, all patients with DUSS scores of three or four required amputation. Conclusion The findings unequivocally demonstrate that higher DUSS scores are strongly associated with adverse clinical outcomes, specifically prolonged hospital stays and increased rates of lower limb amputation. The DUSS proves to be a good prognostic tool for early risk stratification, guiding timely and appropriate therapeutic interventions, but there is a need for clinical judgement and other imaging modalities for better patient care alongside the tool. The study underscores the need for early identification and aggressive management of DFUs, particularly in high-risk populations, and at lower levels of healthcare to improve patient outcomes and alleviate the burden on higher centers.