, Volume 55, Issue 12, pp 3396–3396 | Cite as

Potential inaccuracy in recording the presence of diabetes in people with amputations of the lower limb in hospitals in England



Amputations Diabetes Lower limb Primary care trusts Records Statistics 



Hospital episode statistics


Primary care trust


Shropshire County PCT


Telford and Wrekin PCT

To the Editor: We applaud Holman et al [1] for gathering data regarding the incidence of major lower limb amputations in people with diabetes. However, we believe that comparison of areas covered by primary care trusts (PCTs) is not sufficiently accurate because of poor quality data collection in hospitals in England. Data regarding prevalence of diabetes were gleaned from general practice systems, generated during clinical care. Data recording co-existence of diabetes are taken from hospital episode statistics (HES), usually collected by non-clinical coders, after perusal of hospital notes.

We have examined the case records of all patients coded as having major lower limb amputations in two hospitals that are the major catchment of our two PCTs, for the same time period. There were 21 patients in Shropshire County PCT (SCPCT), and 15 in Telford and Wrekin PCT (TWPCT), a prevalence of 0.58 and 0.71 amputations per year per 1,000 people with diabetes respectively (as opposed to 0.6–0.9 and >1.2, quoted by Holman et al [1]). However, seven of those patients in SCPCT and one from TWPCT were incorrectly coded as not having diabetes, which would have resulted in a false prevalence of 0.36 for SCPCT and 0.66 for TWPCT. We suspect that similar inaccuracies occur in other hospitals in England.

We therefore believe that it is premature to compare areas with small numbers of amputations, such as our PCTs, given that coding for diabetes in relevant patients from HES, as opposed to GP systems, is so inaccurate. Some areas may be unfairly criticised, whilst others become complacent.



The authors thank the audit departments of both hospitals for their help.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

The authors were responsible for the conception, design and drafting of the manuscript, and approved the final version for publication.


  1. 1.
    Holman N, Young RJ, Jeffcoate WJ (2012) Variation in the recorded incidence of amputation of the lower limb in England. Diabetologia 55:1919–1925PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Endocrinology, Hummingbird CentreThe Royal Shrewsbury HospitalShrewsburyUK

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