Clinical characteristics of inpatients with diabetic foot ulcer admitted with non-ulcer complaints: a retrospective study

Background: Patients with diabetic foot (DF) typically have other diabetic complications and comorbidities. DF inpatients admitted with non-ulcer complaints are a neglected group, that might suffer from more non-standard treatments. This study intends to address their clinical characteristics, and clarify the problems existing in the diagnosis and treatment process. Methods: : This study was retrospective. Subjects were eligible inpatients with diabetic foot ulcer (DFU) identified through the relevant International Classification of Disease tenth revision (ICD-10) codes. A structured questionnaire was designed and constructed in sections to collect medical records data. Admission complaints were determined by combining final diagnosis and clinical documentation, and categorized as: ulcer-related or non-ulcer complaints. All discharged patients were followed for readmission and death. Results: : A total of 264 DFU inpatients were included in the final analysis, of which, 80 (30.3%) were admitted with non-ulcer complaints. A total of 82.5% of the DFU inpatients with non-ulcer complaints were admitted to departments without DF specialists. IWGDF/IDSA grade, cerebrovascular diseases, chronic kidney disease, infection in other parts, glycosylated hemoglobin A1c and source of hospitalization expenses were the independent influencing factors for admission with non-ulcer complaints (all P < 0.05). Only 11.3% of the patients with non-ulcer complaints had ever been treated by a DF specialist and/or in a clinical setting with DF specialists, and up to 81.4% had never sought medical help before admission. After admission, 75.0% of the DFU inpatients with non-ulcer complaints received local wound care, and only 12.5% received symptomatic analgesic treatment. There was no significant difference in clinical outcomes between the two groups either in or out-of hospital after discharge (all P > 0.05). Conclusions: : Approximately one-third of inpatients with DFU were admitted with non-ulcer complaints and most of them were admitted to departments without DF specialists. Inpatients with non-ulcer complaints had a milder wound severity but more and heavier comorbidities and worse organ function. These patients did not receive standardized diagnosis and treatment for DFU either before or after admission. They and the medical staff in related departments should receive more attention, education and training.