Comparison of the accuracy of two wound classification systems for
diabetic foot ulcer healing
Dublin Core
Title
Comparison of the accuracy of two wound classification systems for
diabetic foot ulcer healing
diabetic foot ulcer healing
Subject
diabetic foot ulcer; sensitivity, specificity, wound classification,
wound healing prediction
wound healing prediction
Description
Background: Diabetic foot ulcers (DFUs) remain a significant clinical
challenge, requiring precise classification systems to aid prognosis and
treatment planning. The Wagner classification is widely used but offers
limited detail on specific wound characteristics, while the SHID (Suriadi,
Haryanto, Imran, Defa) system provides a more comprehensive evaluation
but lacks validation.
Purpose: This study was designed to evaluate and compare the predictive
validity of the Wagner and SHID classification systems in forecasting DFU
healing outcomes.
Methods: A prospective cohort study was conducted at Kitamura Clinic
and Doctor Soedarso Pontianak Hospital between August 2021 and July
2022, involving 89 DFU patients. Both systems were evaluated based on
sensitivity, specificity, positive predictive value (PPV), negative predictive
value (NPV), and likelihood ratios. Predictive validity was determined using
receiver operating characteristic (ROC) curve analysis and the Youden
index.
Results: A cut-off grade of >2 provided optimal predictive value for both
systems. The SHID classification demonstrated a sensitivity of 92%,
specificity of 62%, PPV of 27.5%, and NPV of 98%, while the Wagner
classification showed a sensitivity of 58%, specificity of 77%, PPV of 28%,
and NPV of 92.2%. Positive likelihood ratios were 2.4 for SHID and 2.5 for
Wagner. ROC analysis yielded an area under the curve (AUC) of 0.786 (95%
CI: 0.69–0.87) for SHID and 0.703 (95% CI: 0.60–0.80) for Wagner. The
Youden index was higher for SHID (0.540) compared to Wagner (0.349).
Conclusion: Although both systems are effective for predicting DFU healing
within 12 weeks, SHID’s superior AUC and Youden index suggest greater
clinical utility in screening and managing DFUs.
challenge, requiring precise classification systems to aid prognosis and
treatment planning. The Wagner classification is widely used but offers
limited detail on specific wound characteristics, while the SHID (Suriadi,
Haryanto, Imran, Defa) system provides a more comprehensive evaluation
but lacks validation.
Purpose: This study was designed to evaluate and compare the predictive
validity of the Wagner and SHID classification systems in forecasting DFU
healing outcomes.
Methods: A prospective cohort study was conducted at Kitamura Clinic
and Doctor Soedarso Pontianak Hospital between August 2021 and July
2022, involving 89 DFU patients. Both systems were evaluated based on
sensitivity, specificity, positive predictive value (PPV), negative predictive
value (NPV), and likelihood ratios. Predictive validity was determined using
receiver operating characteristic (ROC) curve analysis and the Youden
index.
Results: A cut-off grade of >2 provided optimal predictive value for both
systems. The SHID classification demonstrated a sensitivity of 92%,
specificity of 62%, PPV of 27.5%, and NPV of 98%, while the Wagner
classification showed a sensitivity of 58%, specificity of 77%, PPV of 28%,
and NPV of 92.2%. Positive likelihood ratios were 2.4 for SHID and 2.5 for
Wagner. ROC analysis yielded an area under the curve (AUC) of 0.786 (95%
CI: 0.69–0.87) for SHID and 0.703 (95% CI: 0.60–0.80) for Wagner. The
Youden index was higher for SHID (0.540) compared to Wagner (0.349).
Conclusion: Although both systems are effective for predicting DFU healing
within 12 weeks, SHID’s superior AUC and Youden index suggest greater
clinical utility in screening and managing DFUs.
Creator
Kharisma Pratama1 , Suyanto Suyanto2 , Wida Kuswida Bhakti1 ,
Suriadi Jais1*
Suriadi Jais1*
Source
http://jkp.fkep.unpad.ac.id/index.
php/jkp
php/jkp
Date
December 25, 2025
Contributor
peri irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Kharisma Pratama1 , Suyanto Suyanto2 , Wida Kuswida Bhakti1 ,
Suriadi Jais1*, “Comparison of the accuracy of two wound classification systems for
diabetic foot ulcer healing,” Repository Horizon University Indonesia, accessed February 12, 2026, https://repository.horizon.ac.id/items/show/10821.
diabetic foot ulcer healing,” Repository Horizon University Indonesia, accessed February 12, 2026, https://repository.horizon.ac.id/items/show/10821.