Combined Clinical and Laboratory Testing Improves Diagnostic Accuracy for Osteomyelitis in the Diabetic Foot

Fleischer, Adam E.; Didyk, Adam A.; Woods, Jason B.; Burns, Sarah; Wrobel, James S.; Armstrong, David G.

doi:10.1053/j.jfas.2008.09.003

Cited by 95 publications

(81 citation statements)

References 31 publications

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“…The various studies shown that an ESR of greater than 70 mm/hr to be the optimal cut off for positive correlation regarding the presence of osteomyelitis with a reported sensitivity of 90 percent and specificity of 94 to 100 percent. 27,28 Kaleta et al suggested that an ESR level of 70 mm/h might be the optimal cutoff point to predict osteomyelitis with sensitivity of 89.5% and specificity of 100%. 29 The cut-off level of 90 mm/h for ESR had fair specificity for the prediction of major amputation.…”

Section: Resultsmentioning

confidence: 99%

The importance of HbA1C and erythrocyte sedimentation rate as prognostic factors in predicting the outcome of diabetic foot ulcer disease

2017

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Background:The study is to determine the relation between the high HbA1c and ESR as prognostic factors with the severity of the diabetic foot ulcer disease, particularly, in predicting the final outcome in the form of higher incidence of lower extremity amputation (LEA) and/or prolonged hospital stay. The study explored the importance of increased level of serum HbA1c and erythrocyte sedimentation rate (ESR) in determining the final outcome of the disease. It revealed that the severity of diabetic foot ulcer disease is more in patients who had concomitant high levels of baseline HbA1c and ESR on admission. Methods: This observational study was done in 89 patients who were admitted in the surgical wards of the two teaching hospitals in India. The cohort consisted of patients from the age of 26 to 83 years of age who presented with clinically infected foot ulcers. Routine blood tests were done which include HbA1C on the day of admission and fasting ESR (1st hour) on the next day morning. The standard X-ray plates were routinely taken on the first day for determination of the involvement of underlying bones and soft tissues. The outcome of the diabetic foot ulcer was assessed from the severity of the disease according to Meggit-Wagner classification, the incidence of lower extremity amputation and the duration of hospital stay. Results: The high levels of baseline HbA1C (more than 7.0%) in blood on the first day of admission was found in all of the 89 patients who were included in this study but the criteria for consideration of high risk was more than 9% which was found in 41 patients. The criteria for consideration of high ESR in this study was set to be 50 mm/h. High ESR of more than 50 mm was found in 63 patients. We had subdivided 31 patients into a High Risk Group whose baseline levels of HbA1C > 9% and ESR > 50 mm/h. The incidence of amputation was 79.31% and 44.44% with HbA1c of more than 9.0% and ESR of more than 50 mm respectively and was considerably increased (83.87%) when both HbA1c and ESR were more than the critical value as set in the study. Similarly, the incidence of prolonged hospital stay of more than 14 days was 58.54% in patients with HbA1C level of greater than 9 %, 51.85% in patients with baseline ESR > 50 mm/h and 93.55% in presence of high levels of both HbA1C (>9%) and ESR (>50 mm/h).. Conclusions: The study observed that the patients who presented with baseline high levels of HbA1C, ESR or both on admission had unfavourable prognosis with increased incidence of lower extremity amputation and prolonged hospital stay than the other patients in the cohort. .

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Section: Resultsmentioning

confidence: 99%

The importance of HbA1C and erythrocyte sedimentation rate as prognostic factors in predicting the outcome of diabetic foot ulcer disease

2017

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“…22 In a study, erythrocyte sedimentation rate greater than 60 mm/h or C-reactive protein greater than 3.2 mg/dL and ulcer depth greater than 3 mm were reported to be useful markers to determine concomitant bone infection in diabetic foot patients. 23 In another study, white blood cell count was associated with an unfavourable clinical outcome. 22 However, several reports have documented the absence of leukocytosis in the presence of severe foot infections.…”

Section: Discussionmentioning

confidence: 95%

Diabetic Foot Infections and the Role of Doppler USG in Prognosis

Tunçcan¹,

Dizbay²,

Hızel³

et al. 2012

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To determine the value of patient characteristics, laboratory parameters, and imaging procedures in the assessment of the severity and prognosis of diabetic foot infections (DFIs). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Demographic and clinical characteristics of 71 patients with DFI were evaluated retrospectively. Patient characteristics and clinical data including diabetes status and wound related information, laboratory and radiologic findings, and outcomes were recorded. R Re es su ul lt ts s: : In patients between 35 and 60 years old, the frequency of recurrent diabetic foot infections were four and half-times higher than in those over 60 years (OR 4.55, 95% CI 1.50-13.83, p= 0.007). The white blood cell count was significantly higher in severe infections (p<0.05). Gram negative microorganisms were predominantly isolated from the wound cultures of patients aged between 35 and 65 years (p= 0.04). Pathological findings in Doppler Ultrasonography (dUSG) was correlated with smoking (p= 0.004). There was no significant association between the severity of the wound and pathological findings in dUSG. However, presence of a pathological finding in dUSG was correlated with amputation (p=0.001). Moreover, the probability of poor outcome was four-fold higher in patients with a pathology in dUSG in the logistic regression analysis (OR 4.32, 95% CI, 1.24-14.97, p= 0.025). C Co on nc cl lu us si io on n: : In the management of empirical therapy, gram negative microorganisms should be considered, especially in patients of 35-65 years of age. Pathological findings in dUSG were found to be related to poor outcome such as amputation. Therefore, all patients with diabetic foot should be screened with dUSG to identify those at risk for amputation.K Ke ey y W Wo or rd ds s: : Diabetic foot; risk factors; prognosis; ultrasonography, doppler Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmada, diyabetik ayak enfeksiyonlarında klinik, laboratuvar ve radyolojik bulguların enfeksiyon şiddetine ve prognozuna etkisi değerlendirilmiştir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Diyabetik ayak enfeksiyonu olan 71 hasta retrospektif olarak incelenmiştir. Hastaların özellikleri, diyabet ve diyabetik ayak yarası ile ilgili bilgileri, laboratuvar ve radyolojik bulguları ve prognozları değerlendirilmiştir. B Bu ul lg gu ul la ar r: : Hastalarda tekrarlayan lezyon gelişme sıklığının, 35-60 yaş arası hasta grubunda, >60 yaş hasta grubuna göre yaklaşık 4.5 kat fazla olduğu saptanmıştır [Odds Oranı (OO) 4.55, %95 GA 1,50-13,83, p= 0,007]. Şiddetli enfeksiyon ile lökositoz arasında anlamlı bir ilişki saptanmıştır (p< 0,05). Yaşları 35-65 arasında olan hastaların yara yeri kültürlerinde gram negatif mikroorganizlar daha sık izole edilmiştir (p=0,04). Sigara kullanma ile Doppler ultrasonografi (USG) incelemesinde patoloji olması arasında anlamlı bir ilişki bulunmuştur (p= 0,004). Doppler USG'de patoloji ile yaranın ciddiyeti arasında herhangi bir ilişki gözlenmemiştir. ...

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“…In a recent prospective cohort study, independent risk factors for osteomyelitis in a patient with infection of the foot were wounds that extended to bone or joint; previous history of a wound; and recurrent or multiple wounds [194]. Taking together clinical and laboratory findings (ulcer depth >3 mm or CRP >3.2 mg/dL, ulcer depth >3 mm or ESR >60 mm/hour) is likely to help differentiate osteomyelitis from cellulitis [195]. Although the presence of a local ulceration (toe or metatarsophalangeal joint) or a "sausage toe" (swollen, erythematous, and lacking normal contours) [196] is suggestive of the diagnosis, there is no specific clinical finding of DFO.…”

Section: Evidence Summarymentioning

confidence: 99%

Risk Factors of Methicillin-Resistant Staphylococcus Aureus and Pseudomonas Infection in Diabetic Foot Ulcers in Korea

Lee

Son

Han

2017

J Wound Management Res

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Combined Clinical and Laboratory Testing Improves Diagnostic Accuracy for Osteomyelitis in the Diabetic Foot

Cited by 95 publications

References 31 publications

The importance of HbA1C and erythrocyte sedimentation rate as prognostic factors in predicting the outcome of diabetic foot ulcer disease

The importance of HbA1C and erythrocyte sedimentation rate as prognostic factors in predicting the outcome of diabetic foot ulcer disease

Diabetic Foot Infections and the Role of Doppler USG in Prognosis

Risk Factors of Methicillin-Resistant Staphylococcus Aureus and Pseudomonas Infection in Diabetic Foot Ulcers in Korea

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