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Cellulitis

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Clinical features

Think about osteomyelitis in patients with diabetes and foot ulcers and any of the following: a
  • clinical suspicion
  • ulcer area >2 cm2
  • bone exposed within ulcer
  • bone palpable (by probe) in ulcer

Why?

Clinical suspicion, large ulcers and detectable bone increase the chance of osteomyelitis

Patient a Target Disorder and
Reference Standard		 Diagnostic Test LR+
(95% CI) 		Post-test Probability LR-
(95% CI) 		Post-test Probability
diabetes and infected foot ulcer
(pre-test probability: 68%) 		osteomyelitis
(histology) 		clinical suspicion infinity
(2.1 to infinity) 		100% 0.83
(0.75 to 0.92) 		64%
    ulcer area > 2cm2 3.6
(1.2 to 11) 		88% 0.76
(0.63 to 0.91) 		62%
    bone exposed within ulcer infinity
(0.21 to infinity) 		100% 0.83
(0.75 to 0.92) 		64%
    bone palpable in ulcer 3.9
(1.5 to 10) 		89% 0.63
(0.50 to 0.80) 		58%

Expiry date: January 2004
Levels of Evidence used in grading these guides

Authors   J   Epling , CM   Ball
Reviewer   C   Conlon
CAT Writers   J   Epling , CM   Ball