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Classifications: Who Needs 'em? Classifications: Who Needs ‘Em? It’s final examination time here at the Western University College of Podiatric Medicine. Our students are stressing out over their Podiatric Medical Principles class, wondering what’s going to be on the exam. Of course, the answer to at least part of that is obvious: classifications. Of all the topics that can be asked, whether it’s at the student, residency applicant, or Boards examinee level, we all know that classifications is that one subject that’s going to come up. It's All Classified It’s amazing just how many classification schemes exist and how much this concept is used in research. I did a quick Pubmed search using the term classifications (not very selective, I know) and came up with 549,325 articles! There’s a classification for everything. From tumors to trauma, infections to inflammation, there’s a classification to fit every taste and style. You name the disease process, it probably has a classification. Oddly, there’s no classification for flatulence. Hmmm. Wonder why? Just for fun, here’s a very small selective list of classification systems that we “need to know” in our field of podiatric medicine (with the disease in parentheses). Consider this a stroll down memory lane, stopping by to see some “old friends” from yesteryear, auld lang syne.
The Big Questions Why are there so many classification systems? What good are they anyway? Do classifications matter for those of us in practice? How about residency? Are they more than just questions for residency and Boards interviews? The Theories I don’t know the comprehensive answer to these questions, but I do have a few theories. First, since the beginning of human culture, we’ve been trying to “name everything,” to describe what we see around us. Whether it’s the Bible or Carl Linneus creating the biological classification system, humans have a powerful desire to categorize the world around us in "order" to understand the order in it. We in the medical profession are just continuing the same endeavor that has been a constant throughout human history. From a purely clinical perspective, good classification systems tell us something important about the diseases we intend to treat. For example, the Hawkins talar neck fracture classification is useful because it gives us a prognosis for our patients. A Hawkins 4 assignment allows me to tell my patient he has an almost 100% chance of talar avascular necrosis. Similarly, a useful classification will tell us something about the anatomy and physiology involved. The Lauge Hansen system for ankle fractures allows the surgeon to understand the mechanism of injury (assisting with reduction of the fracture) while also predicting associated soft tissue damage. On the other hand, the UT wound classification provides information about wound severity by grading depth and staging the physiological status (ischemia, infection, or the combination of the two).
Although classifications are also useful for research, my problem with the vast majority of them is they give us no particularly useful information and seem to be a way to get another name in the medical literature. Notice the vast majority of the above schemes are eponymously named. Want to have a bunch of people use your name? You’ll either invent a surgical instrument or create a classification system. Don't bother with how useful it is – or isn’t. The Wagner classification, for example, although heavily used for diabetic wounds, was actually created for ischemic wounds and tells us nothing about the physiologic status of a wound. Simple but useless. What do you think about classifications? Useful or not? Of course, no matter what we all think, classifications are here to stay. We still need those Boards questions. I wonder…maybe the world really does need a flatulence classification. The Shapiro flatulence classification? Hmmm. Maybe not. Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum. Best wishes.
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