Endocrine Abstracts

Aims/objectives: The aim of this retrospective audit on MANAGEMENT OF ACUTE CHARCOT ARTHROPATHY was to assess the current practice at King’s Mill hospital against the latest National institute of clinical excellence guidelines.

Methods: A retrospective audit of 22 patients with diabetes presented with acute Charcot neuro-arthropathy, between January 2016 and August 2018 to the specialist diabetes foot team at KMH. The data was collected from the hospital software systems ICE, ORION, EPRO and patients’ files.

Results: Of These 22 patients 16 were males, 18 patients (31.82%) were type 2 diabetics. 31.82% patients had diabetes duration >20 years, 27.28% for 10 to 19 years, 31.82% patients 5 to 10 years whereas 9.09% patients had less than 5 years. 59.09% patients had associated ulcer on foot. 27.27% patients had history of fracture of the affected foot in the past, whereas 36.36% patients had history of previous amputation. 81.82% patients were known to have peripheral neuropathy and 40.91% had history of CKD. 72.27% patients were known to have hypertension, 45.45% hyperlipidemia and 40.91% patients had history of cardiovascular disease. Charcot was on right side in 72.73%. All the patients had clinical suspicion which was later confirmed on MRI in 54.55%, whereas 22.73% had single X-ray. Temperature difference was not documented in 4.55%. 54.55% had less than 3 degrees difference whereas remaining had more than 3 degrees difference. 90.91% patients had documented advice of weight off-loading. 50% had removable cast and 50% had non-removable ones. 90.91% patients had serial temperatures documented and 4.55% patients had serial x-rays done. 50% patients had complete resolution of acute arthropathy, whereas others had partial resolution so far.

Conclusions: The audit demonstrated that all the patients were given cast (removable or non-removable) and were followed up in MDS Diabetes Foot Clinic. Temperature difference on presentation was documented in 95.45%. However the two key concerns were that only 4.55% patients had serial X-rays done for monitoring and 09.09% patients did not have documented advice of weight off-loading. It is really important to check and document temperature difference and do serial X-rays during follow up of these patients in order to bridge the gap between current recommendations and clinical practice.