title: Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis.
abstract: 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.
authors.affiliation: Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison.
authors.forename: Marie T
authors.initials: MT
authors.lastname: Dinh
authors.forename: Cybele L
authors.initials: CL
authors.lastname: Abad
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
mesh_terms: D017719:Diabetic Foot / Q000150:complications*; D003952:Diagnostic Imaging / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007205:Indium Radioisotopes; D007962:Leukocytes; D008279:Magnetic Resonance Imaging; D008991:Monitoring, Physiologic; D010019:Osteomyelitis / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015125:Oxyquinoline; D010808:Physical Examination; D011859:Radiography; D011877:Radionuclide Imaging / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D007205:Indium Radioisotopes; D015125:Oxyquinoline