There are as many classification systems for wounds as there are clinicians who believe they have developed the proverbial “better mousetrap.” The various wound classification systems include the Wagner classification, the University of Texas scheme, the S(AD) SAD classification, the Red Yellow Black breakdown, which is prominent in the nursing
literature, the PEDIS classification and the DEPA Score.
Several questions invariably come up in a discussion of these classification systems. Does the private practitioner use any of them? Should the clinician use a classification system? If so, which one should the clinician use? Most of us use a classification system in our chart notes when describing a wound but questions still abound about which system is best.
There are four main advantages of using a well-designed wound classification system in practice. A well-designed classification scheme:
• provides a valuable means for organization;
• represents a common language for speaking with other medical professionals;
• can help with reimbursement issues; and
• provides validation of chosen treatments.
Emphasizing The Benefits Of Organization And A Common Language
For the researcher and the private practitioner who enjoys contributing to the literature, using a classification system is imperative as it allows one to categorize similar wounds (i.e. comparing all patients with forefoot gangrene).
Organization allows practitioners to retrieve information easily from large databases for comparison. Even the most efficient description appearing in chart notes, without the benefit of categorization into a classification system, makes a review of data cumbersome and unreliable.
When we were residents, we were all trained to speak the common language of fractures when discussing what we were seeing in imaging studies. That common language cut through any potential confusion when discussing pathology and potential treatments. Unfortunately, the same respect is not always given to the foot wound.
The physician can ensure he or she is getting the consultation that the patient requires if he or she is able to convey to other services the exact nature of the problem. Likewise with referrals, the old adage of “garbage in, garbage out,” explains the problem with inexact descriptions.
Underscoring The Importance Of Using A Validated Classification System
As we all know, third party payers often use clerks to make crucial decisions about a patient’s care, depending upon the symptoms, systems involved, severity and other key factors. Obviously, these clerks may only have a superficial understanding of the clinical issues involved. Using a validated classification system allows the third party payer to have access to that information. The validation of the wound classification system facilitates recognition by payers and the medical community at large because the system is verifiable.
Indeed, validated classification systems have been shown to have reproducible outcomes. This leads to proven treatment protocols for the wounds in that category. With limited resources available, it is important to be able to reliably predict an outcome for any given treatment. It is also a method that will often allow a practitioner to use a cutting edge treatment to treat and cure a wound more effectively rather than utilizing an inexpensive modality to continue to treat a patient’s wound in a palliative manner for a much longer time. For example, using a validated wound classification scheme may make it easier for a clinician to use the Wound VAC®
(KCI) versus saline soaked gauze.
Weighing The Merits Of The Wagner System
The Wagner system is the most widely recognized and utilized classification for foot wounds, and is still mentioned in the medical literature with great frequency. However, as one research group said, “The basic problem inherent to any classification system for any disease is that the ease of its application is inversely related to its clinical accuracy.”1
While the Wagner classification is a simple, easy to remember system, based upon the location and depth of ulcerations, one should be aware of the system’s limitations.2
The Wagner classification does not take the presence of neuropathy or the size of the lesion into account.