title: Validating the probe-to-bone test and other tests for diagnosing chronic osteomyelitis in the diabetic foot.
abstract: OBJECTIVE
  To compare the diagnostic characteristics of tests used for a prompt diagnosis of chronic osteomyelitis in the diabetic foot, using bone histology as the criterion standard. The tests assessed were probe-to-bone (PTB), clinical signs of infection, radiography signs of osteomyelitis, and ulcer specimen culture.
  
  
  METHODS
  A prospective study was performed on patients with foot ulcers referred to our diabetic foot clinic. Ulcer infection was diagnosed by recording clinical signs of infection and taking specimens for culture. The presumptive diagnosis of osteomyelitis was based on these results and the findings of a plain X-ray and PTB test. All patients with a clinical suspicion of bone infection were subjected to surgical treatment of the affected bone. During surgery, bone specimens were obtained for a histological diagnosis of osteomyelitis.
  
  
  RESULTS
  Over 2.5 years, 210 foot lesions were consecutively examined and 132 of these wounds with clinical suspicion of infection selected as the study sample. Of these, 105 (79.5%) lesions were diagnosed as osteomyelitis. Among the tests compared, the best results were yielded by the PTB test including an efficiency of 94%, sensitivity of 98%, specificity of 78%, positive predictive value of 95%, and negative predictive value of 91% (P < 0.001, κ 0.803); the positive likelihood ratio was 4.41, and the negative likelihood ratio was 0.02 (95% CI).
  
  
  CONCLUSIONS
  In our outpatient population with a high prevalence of osteomyelitis, the PTB test was of greatest diagnostic value, especially for neuropathic ulcers, and proved to be efficient for detecting osteomyelitis in the diabetic foot.
authors.affiliation: University Podology Clinic, Faculty of Medicine, Universidad Complutense de Madrid, Madrid,Spain. rmorales@enf.ucm.es
authors.forename: Rosario
authors.initials: R
authors.lastname: Morales Lozano
authors.forename: Maria L
authors.initials: ML
authors.lastname: González Fernández
authors.forename: David
authors.initials: D
authors.lastname: Martinez Hernández
authors.forename: Juan V
authors.initials: JV
authors.lastname: Beneit Montesinos
authors.forename: Sagrario
authors.initials: S
authors.lastname: Guisado Jiménez
authors.forename: Maximo A
authors.initials: MA
authors.lastname: Gonzalez Jurado
mesh_terms: D002908:Chronic Disease; D017719:Diabetic Foot / Q000150:complications*; D006801:Humans; D015999:Multivariate Analysis; D010019:Osteomyelitis / Q000150:complications* / Q000175:diagnosis*; D011446:Prospective Studies