Comparison of Wagner and University of Texas Classification Systems as Predictors of Amputation in Patients with Diabetic Foot

Abstract

Introduction: Diabetic foot ulcers (DFUs) are a major complication of diabetes and a leading cause of lower-limb amputations. Classification systems are essential in evaluating ulcer severity and guiding treatment strategies. Among the most commonly used are the Wagner and University of Texas (UT) systems. Objectives: To compare the frequency of high and low scores in the Wagner and UT classification systems in patients with diabetic foot ulcers and to evaluate the frequency of amputation associated with these classifications. Methods: This prospective observation study was conducted on 100 patients aged 40–70 years presenting with diabetic foot ulcers at our tertiary care hospital for the duration of one year, from December 2023 to December 2024. Patients were assessed using both the Wagner and University of Texas classification systems. Those with liver disease, coagulopathies, malignancy, or trauma-related ulcers were excluded. Follow-up continued for eight weeks to monitor ulcer progression and document any amputations. Results: The majority of patients had low-grade ulcers according to both classification systems. However, a higher frequency of amputations was observed in patients with high-grade scores. The UT classification, though identifying fewer high-grade ulcers than the Wagner system, was associated with a higher rate of amputation, indicating potentially greater sensitivity in predicting adverse outcomes. Conclusion: Both the Wagner and UT systems are valuable in assessing diabetic foot ulcer severity, but the UT classification may offer improved prognostic value in identifying patients at higher risk of amputation. Further research with larger cohorts and broader clinical settings is recommended to validate these findings.