The Application of Digital Frailty Screening to Triage Nonhealing and Complex Wounds

Abstract

Objective: We investigated the association between the complexity of diabetic foot ulcers (DFUs) and frailty. Research Design and Methods: Individuals (n = 38) with Grade 2 Wagner DFU were classified into 3 groups based on the Society for Vascular Surgery risk-stratification for major limb amputation as Stage 1 at very low risk (n = 19), Stage 2 at low risk (n = 9), and Stage 3 to 4 at moderate-to-high risk (n = 10) of major limb amputation. Frailty status was objectively assessed using a validated digital frailty meter (FM). The FM works by quantifying weakness, slowness, rigidity, and exhaustion over a 20-second repetitive elbow flexion-extension exercise using a wrist-worn sensor. FM generates a frailty index (FI) ranging from 0 to 1; higher values indicate progressively greater severity of frailty. Skin perfusion pressure (SPP), albumin, and tissue oxygenation level (SatO 2 ) were also measured. One-way analysis of variance (ANOVA) was used to identify group effect for wound complexity. Pearson’s correlation coefficient was used to assess the associations with frailty and clinical endpoints. Results: Frailty index was higher in Stage 3 and 4 as compared to Stage 1 ( d = 1.4, P < .01) and Stage 2 ( d = 1.2, P < .01). Among assessed frailty phenotypes, exhaustion was correlated with SPP ( r = −0.63, P < .01) and albumin ( r = −0.5, P < .01). Conclusion: Digital biomarkers of frailty may predict complexity of DFU and thus triage individuals who can be treated more simply in their primary clinic versus higher risk patients who require prompt referral to multidisciplinary, more complex care.