Chronic neuropathic ulcer is not the most common antecedent of lower limb infection or amputation among diabetics admitted to a regional hospital in Jamaica: results from a prospective cohort study

Table 2 Antecedent events for lower limb infection (and/or gangrene) and amputation

Antecedent/precipitating event	Frequency (%)	^aNo.(% of total) amputation	^bNo.(% of total) major amputation
Acute idiopathic soft tissue infection/ulcer^c	39 (30.5 %)	26 (34.7 %)	11 (26.8 %)
Chronic neuropathic ulcer	30 (23.4 %)	18 (24 %)	9 (22 %)
Closed puncture wound	25 (19.5 %)	^d6/23 (8 %)	^d2/23 (4.9 %)
Critical ischemia	10 (7.8 %)	^e9/9 (12 %)	^e9/9 (22 %)
Bruise/blunt trauma	9 (7 %)	7 (9.3 %)	4 (9.8 %)
Laceration	5 (3.9 %)	3 (4 %)	1 (2.4 %)
Furuncle on lower limb	2 (1.6 %)	0	0
Chronic leg ulcer (venous)	2 (1.6 %)	1 (1.3 %)	1 (2.4 %)
Hot water burn	1 (0.8 %)	1 (1.3 %)	1 (2.4 %)
Sunburn	^f1 (0.8 %)
Ingrown toenail	1 (0.8 %)	1 (1.3 %	0
Toenail fungus	1 (0.8 %)	1 (1.3 %)	1 (2.4 %)
Bullosis diabeticorum	1 (0.8 %)	1 (1.3 %)	1 (2.4 %)
Re-infection of surgical wound	1 (0.8 %)	1 (1.3 %)	1 (2.4 %)
Total	128 (100 %)	75 (100 %)	41 (100 %)

^aAmputation at any level out of 124 patient-episodes (four patient-episodes lost to follow-up)
^bMajor amputation, defined as transmetatarsal or higher, out of 124 patient-episodes (four patient-episodes lost to follow-up)
^cThis category includes soft tissue infections with unbroken skin or ulcers present for less than 1 month (in which temporal continuity between initial soft tissue infection and breakdown of the skin occurred over this period)
^dTwo patients, who did not have an amputation during initial admission, were subsequently lost to follow-up
^eOne patient with critical limb ischemia and gangrene who was offered amputation discharged himself from hospital and was lost to follow-up
^fThis patient developed superficial dry gangrene of her second toe and was offered amputation but refused and was lost to follow-up

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