Aim: Delays in referrals from primary care to specialist care clinics are a common issue in the clinical management of diabetic foot disease and are associated with worse clinical outcomes in terms of ulcer healing and major amputations (1-3). One reasons for the delays may be the complexity of risk stratification; a number of different risk factors, such as foot deformity, neuropathy and peripheral arterial disease, interact and influence the risk of developing diabetic foot complications. The aim was to illustrate how decision trees can be constructed to facilitate risk stratification.
Methods: A decision tree (4) was created based on the risk stratification described in the guideline document by the National Institute for Health and Care Excellence (NICE) (5).
Results: With the help of the decision tree in Figure 1, clinicians without specialised knowledge in diabetic foot disease can stratify all diabetic feet with only four decision points or less. This could facilitate accurate risk stratification and timely referral of patients.
Conclusions: Even complex risk stratifications as the one described by NICE can be transformed into simple decision trees for use in busy clinics. Future studies should investigate whether the use of decision trees lead to more accurate risk stratifications and referrals, improving the outcomes for people with diabetic foot disease.