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Risk Factors for Amputation in Diabetics
- Gayle E. Reiber, MD; and
- Thomas D. Koepsell, MD
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IN RESPONSE:
Our inclusion criterion was an “initial amputation of the affected lower extremity” [1]. We did not study the preamputation treatment strategy and factors leading to the decision to amputate. We did, however, address many health care provider and patient risk factors where intervention could minimize the risk for limb loss.
As for infection in the cases and controls, including osteomyelitis, 68% of cases had an active infection of the affected lower extremity [1]. Infection was dichotomized as present or absent, based on physical examination, microbiologic culture results, radiologic studies, and pathology reports. The criteria for control selection excluded persons with chronic lower-extremity ulcers of over 4 weeks duration. Chronic ulceration usually precedes infection, and infection is unlikely without cutaneous involvement. Of 236 controls, 22 had a superficial cut or scratch of less than 4 weeks duration, and 1 had a resolving superficial infection. Thus, controls had no lower-extremity ulcers or serious infections (including osteomyelitis).
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
