Prevalence
Clinical
features
Differential
Diagnosis
Investigations
Therapy
Prevention
Prognosis
|  | | | Investigations |
If osteomyelitis is a possibility consider
a
Why?
A grossly raised ESR is diagnostic
| Patient |
Target Disorder and
Reference Standard |
Diagnostic Test |
LR+
(95% CI)
|
Post-test Probability |
LR-
(95% CI)
|
Post-test Probability |
diabetes and infected foot ulcer
a
(pre-test probability: 68%)
|
osteomyelitis
(histology)
|
ESR > 100 mm/hour
|
infinity
(1.3 to
infinity)
|
100% |
0.89
(0.83 to
0.97)
|
66% |
|
|
|
bone scan
|
0.52
(0.36 to
0.75)
|
53% |
2.2
(1.3 to
3.8)
|
82% |
diabetes and admitted with foot ulcer or cellulitis
c
(pre-test probability: 46%)
|
deep infection
(surgery or long-term antibiotics)
|
MRI
|
3.9
(1.4 to
11)
|
77% |
0.12
(0.018 to
0.78)
|
9% |
Note:
-
X-rays and leukocyte scans are unhelpful.
a
X-rays and leukocyte scans do not help diagnose or exclude osteomyelitis in diabetes.
| Patient |
Target Disorder and
Reference Standard |
Diagnostic Test |
LR+
(95% CI)
|
Post-test Probability |
LR-
(95% CI)
|
Post-test Probability |
diabetes
a
(pre-test probability: 68%)
|
osteomyelitis
(histology)
|
x-ray
|
1.7
(0.51 to
5.7)
|
79% |
0.93
(0.81 to
1.1)
|
67% |
|
|
|
24 hr leukocyte scans
|
1.3
(0.75 to
2.3)
|
74% |
0.86
(0.64 to
1.2)
|
65% |
|
internal medicine