Previously submitted to: Interactive Journal of Medical Research (no longer under consideration since Jan 12, 2023)
Date Submitted: Aug 14, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Analysis of pre-hospital delay in Chinese patients with diabetic foot ulcers: based on 46 cases.
ABSTRACT
Background:
Diabetes mellitus (DM) is a chronic condition caused by impaired regulation of blood glucose levels. The number of adult diabetic patients in China is a total of 116.4 million, among which the incidence of diabetic foot (DF) is as high as 15% ~ 25%. Estimates of the prevalence of foot ulceration vary, but around 1% to 4% of people with DM have foot ulcers at any given time which has a serious impact on health-related quality of life, particularly with respect to physical functioning and role-limitations due to physical and emotional issues. According to the National Institute for Health and Care Excellence (NICE), the DFUs patients are considered having pre-hospital delay if the interval between the first discovery of foot ulcers to the first visit to a hospital with a diabetic foot specialist treatment team was more than 24h. Some studies have shown that most patients with DFUs do not seek medical treatment in a timely manner. Delays in seeking medical treatment can significantly increase the risk of amputation and death. Therefore, the overall aim of this study is to analyze DFU patients’ treatment-seeking behaviors.
Objective:
To study the causes of pre-hospital delay in Chinese patients with diabetic foot ulcers (DFUs).
Methods:
A retrospective study, investigating a case series of 46 DFUs treated at a single hospital, was conducted to evaluate wound condition, wound treatment, costs and patients’ complete medical records, and analyze the reasons causing the pre-hospital delay.
Results:
We assessed 46 DFUs aged between 53 to 92 years old. The average pre-hospital delay was 5 months, with nearly 20% being delayed for more than 1 year. The average length of hospital stay in China was 21 days, with an average cost of $8672. Recurrence rate of diabetic foot ulcers was 21%, and three patients were recommended to transfer to upper-level hospital. Besides, the intervention was limited and homogenous and medical records were incomplete.
Conclusions:
Medical service users’ limited understanding of diseases, high costs that patients need to afford, and unsatisfactory treatment by medical service providers are the main reasons for patients’ delay in seeking treatment. Recommendations are offered to reduce the pre-hospital delay of Chinese patients with DFUs.
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