Journal Article

Diagnostic Accuracy of the Physical Examination and Imaging Tests for Osteomyelitis Underlying Diabetic Foot Ulcers: Meta-Analysis

Marie T. Dinh, Cybele L. Abad and Nasia Safdar

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 47, issue 4, pages 519-527
Published in print August 2008 | ISSN: 1058-4838
Published online August 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/590011
Diagnostic Accuracy of the Physical Examination and Imaging Tests for Osteomyelitis Underlying Diabetic Foot Ulcers: Meta-Analysis

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Accurate diagnosis of osteomyelitis underlying diabetic foot ulcers is essential to optimize outcomes. We undertook a meta-analysis of the accuracy of diagnostic tests for osteomyelitis in diabetic patients with foot ulcers. Pooled sensitivity and specificity, the summary measure of accuracy (Q*), and diagnostic odds ratio were calculated. Exposed bone or probe-to-bone test had a sensitivity of 0.60 and a specificity of 0.91. Plain radiography had a sensitivity of 0.54 and a specificity of 0.68. MRI had a sensitivity of 0.90 and a specificity of 0.79. Bone scan was found to have a sensitivity of 0.81 and a specificity of 0.28. Leukocyte scan was found to have a sensitivity of 0.74 and a specificity of 0.68. The diagnostic odds ratios for clinical examination, radiography, MRI, bone scan, and leukocyte scan were 49.45, 2.84, 24.36, 2.10, and 10.07, respectively. The presence of exposed bone or a positive probe-to-bone test result is moderately predictive of osteomyelitis. MRI is the most accurate imaging test for diagnosis of osteomyelitis.

Journal Article.  4148 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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