title: Is there a simple, definitive, and cost-effective way to diagnose osteomyelitis in the pressure ulcer patient?
abstract: BACKGROUND
  Despite advances in managing pressure ulcers, there is still no definitive way to diagnose bone infection (osteomyelitis) short of open biopsy. An effective, less invasive diagnostic method might result in cost savings and improved care; however, needle aspiration, computed tomography scan, magnetic resonance imaging, ultrasound, and bone scans have proven unsatisfactory in predicting osteomyelitis. The authors reviewed preoperative radiologic studies of stage IV pressure ulcer patients and their bone biopsy results to determine which radiologic studies are most diagnostic for osteomyelitis.
  
  
  METHODS
  Patients (n = 44) having surgical débridement of stage IV ulcers with open bone biopsy after prior radiographic imaging (plain films, ultrasound, computed tomography, magnetic resonance imaging, and/or nuclear bone scans) were included. Studies were interpreted by a single musculoskeletal radiologist blinded to information from the medical record and following standard radiologic criteria for the diagnosis of osteomyelitis.
  
  
  RESULTS
  The percentage of patients with biopsy-proven osteomyelitis identified with imaging was 50 percent using a computed tomography scan and 88 percent using a plain film of the bony area of involvement. The overall sensitivity of either radiologic study was 61 percent. The percentage of patients without osteomyelitis identified as not having the condition by imaging was 85 percent for the computed tomography scan and 32 percent for the plain film. Overall specificity of both studies was 69 percent.
  
  
  CONCLUSIONS
  Preoperative radiologic studies for osteomyelitis in a pressure ulcer are far from definitive; however, if a radiologic study is used to make that diagnosis in a stage IV pressure ulcer, it would appear that a plain film would suffice.
authors.affiliation: Milwaukee, Wisc.; Allentown, Pa.; and Miami, Fla. From the Departments of Plastic Surgery and Radiology, Medical College of Wisconsin; Division of Plastic Surgery, Department of Surgery, Lehigh Valley Health Network; and University of Miami School of Medicine.
authors.forename: David L
authors.initials: DL
authors.lastname: Larson
authors.forename: Jarom
authors.initials: J
authors.lastname: Gilstrap
authors.forename: Kevin
authors.initials: K
authors.lastname: Simonelic
authors.forename: Guillermo F
authors.initials: GF
authors.lastname: Carrera
mesh_terms: D003362:Cost-Benefit Analysis; D005269:Femur / Q000473:pathology; D006801:Humans; D007512:Ischium / Q000473:pathology; D010019:Osteomyelitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D003668:Pressure Ulcer / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies; D012447:Sacrum / Q000473:pathology; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed