Pre-hospital delay > 7 days independently predicts impaired wound healing in diabetic foot ulcer patients: a 3-year retrospective cohort study.
Diabetic foot ulcers (DFUs) are a severe, costly complication of diabetes and a major public health challenge. Early multidisciplinary intervention is critical. This study investigated how pre-hospital practices affect clinical characteristics, metabolic profiles, and outcomes in DFU patients.
A retrospective cohort study included DFU patients treated at a tertiary center (2021-2024). Patients were stratified into the timely medical care group (TMCG, ≤ 7 days) and the delayed medical care group (DMCG, 7-30 days) based on initial consultation timing. Comparative analysis evaluated metabolic parameters and lesion severity. Kaplan-Meier analysis was performed to assess healing outcomes, and multivariable Cox regression was used to identify predictors of DFU healing.
A total of 116 patients were enrolled in this study. A high proportion of patients in both the TMCG (n = 49) and DMCG (n = 67) had used Chinese herbal medicine or topical Western medications prior to admission. Compared to patients in the TMCG, those in the DMCG were associated with more severe Wagner grades (≥ 3: 38.8% vs. 18.4%, p = 0.02), hypoalbuminemia (< 35 g/L: 62.7% vs. 40.8%, p = 0.02), and higher rates of surgical intervention (14.9% vs. 4.1%, p = 0.02). Kaplan-Meier analysis revealed that the DMCG had a significantly higher risk of non-healing than the TMCG (p = 0.002). Multivariate Cox regression analysis identified delayed medical care (7-30 days) (HR = 1.62, 95% CI: 1.02-2.56, p = 0.04), and a higher Wagner grade (HR = 1.62, 95% CI: 1.19-2.22, p = 0.003) as independent predictors of impaired DFU healing.
Inappropriate pre-hospital practices commonly delay definitive care and worsen outcomes. Early medical intervention (≤ 1 week) is positively associated with therapeutic outcomes and reduces the risk of complications.
A retrospective cohort study included DFU patients treated at a tertiary center (2021-2024). Patients were stratified into the timely medical care group (TMCG, ≤ 7 days) and the delayed medical care group (DMCG, 7-30 days) based on initial consultation timing. Comparative analysis evaluated metabolic parameters and lesion severity. Kaplan-Meier analysis was performed to assess healing outcomes, and multivariable Cox regression was used to identify predictors of DFU healing.
A total of 116 patients were enrolled in this study. A high proportion of patients in both the TMCG (n = 49) and DMCG (n = 67) had used Chinese herbal medicine or topical Western medications prior to admission. Compared to patients in the TMCG, those in the DMCG were associated with more severe Wagner grades (≥ 3: 38.8% vs. 18.4%, p = 0.02), hypoalbuminemia (< 35 g/L: 62.7% vs. 40.8%, p = 0.02), and higher rates of surgical intervention (14.9% vs. 4.1%, p = 0.02). Kaplan-Meier analysis revealed that the DMCG had a significantly higher risk of non-healing than the TMCG (p = 0.002). Multivariate Cox regression analysis identified delayed medical care (7-30 days) (HR = 1.62, 95% CI: 1.02-2.56, p = 0.04), and a higher Wagner grade (HR = 1.62, 95% CI: 1.19-2.22, p = 0.003) as independent predictors of impaired DFU healing.
Inappropriate pre-hospital practices commonly delay definitive care and worsen outcomes. Early medical intervention (≤ 1 week) is positively associated with therapeutic outcomes and reduces the risk of complications.