advertising
-
1
Pecoraro RE, Reiber GE, Burgess EM: Pathways to diabetic limb amputation: basis for prevention. .Diabetes Care 13::513. ,1990. .
-
2
Fox HR, Karchmer AW: Management of diabetic foot infections, including the use of home intravenous antibiotic therapy. .Clin Podiatr Med Surg 13::671. ,1996. .
-
3
Wrobel JS, Connolly JE: Making the diagnosis of osteomyelitis: the role of prevalence. .JAPMA 88::337. ,1998. .
-
4
Grayson ML, Gibbons GW, Balogh K, et al: Probing to bone in infected pedal ulcers: a clinical sign of underlying osteomyelitis in diabetic patients. .JAMA 273::721. ,1995. .
-
5
Lipsky BA, Pecoraro RE, Wheat LJ: The diabetic foot: soft tissue and bone infection. .Infect Dis Clin North Am 4::409. ,1990. .
-
6
Leichter SB, Allweiss P, Harley J, et al: Clinical characteristics of diabetic patients with serious pedal infections. .Metabolism 37 (suppl 1)::22. ,1988. .
-
7
Armstrong DG, Lavery LA, Sariaya M, et al: Leukocytosis is a poor indicator of acute osteomyelitis of the foot in diabetes mellitus. .J Foot Ankle Surg 35::280. ,1996. .
-
8
Zlonis M: The mystique of the erythrocyte sedimentation rate: a reappraisal of one of the oldest laboratory tests still in use. .Clin Lab Med 13::787. ,1993. .
-
9
Brigden ML: The erythrocyte sedimentation rate: still a helpful test when used judiciously. .Postgrad Med 103::257. ,1998. .
-
10
Sox HC, Liang MH: The erythrocyte sedimentation rate: guidelines for rational use. .Ann Intern Med 104::515. ,1986. .
-
11
Bedell SE, Bush BT: Erythrocyte sedimentation rate: from folklore to facts. .Am J Med 78::1001. ,1985. .
-
12
Brigden ML: Clinical utility of the erythrocyte sedimentation rate. .Am Fam Physician 60::1443. ,1999. .
-
13
Covey DC, Albright J: Clinical significance of the erythrocyte sedimentation rate in orthopaedic surgery. .J Bone Joint Surg Am 69::148. ,1987. .
-
14
Carragee EJ, Kim D, van der Vlugt T, et al: The clinical use of erythrocyte sedimentation rate in pyogenic vertebral osteomyelitis. .Spine 22::2089. ,1997. .
-
15
Jones NS, Anderson DJ, Stiles PJ: Osteomyelitis in a general hospital: a five-year study showing an increase in subacute osteomyelitis. .J Bone Joint Surg Br 69::779. ,1987. .
-
16
Lewis VL, Jr, Bailey MH, Pulawski G, et al: The diagnosis of osteomyelitis in patients with pressure sores. .Plast Reconstr Surg 81::229. ,1988. .
-
17
American Diabetes Association: The Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. American Diabetes Association, Alexandria, VA, 2000..
-
18
Lavery LA, Armstrong DG, Quebedeaux TL, et al: Puncture wounds: normal laboratory values in the face of severe infection in diabetics and non-diabetics. .Am J Med 101::521. ,1996. .
-
19
Ishak R, Hassan K: The erythrocyte sedimentation rate, C-reactive protein, plasma fibrinogen and viscosity in chronic renal disease patients with infection. .Malays J Pathol 11::29. ,1989. .
-
20
Sliwinski AJ, Weber LD, Nashel DJ: C-reactive protein versus erythrocyte sedimentation rate: a comparison of effectiveness as an infection marker in patients undergoing peritoneal dialysis. .Arch Pathol Lab Med 107::387. ,1983. .
-
21
Bottiger LE, Svedberg CA: Normal erythrocyte sedimentation rate and age. .Br Med J 2::85. ,1967. .
-
22
Boyd RV, Hoffbrand BI: Erythrocyte sedimentation rate in elderly hospital in-patients. .Br Med J 1::901. ,1966. .
-
23
Bain BJ: Some influences on the ESR and the fibrinogen level in healthy subjects. .Clin Lab Haematol 5::45. ,1983. .
-
24
Lascari AD: The erythrocyte sedimentation rate. .Pediatric Clin North Am 19::1113. ,1972. .
-
25
Mayne EE, Bridges JM, Weaver JA: Platelet adhesiveness, plasma fibrinogen and factor 8 levels in diabetes mellitus. .Diabetologia 6::436. ,1970. .
-
26
Memeh CU: Differences between plasma viscosity and proteins of types 1 and 2 diabetic Africans in early phase of diabetes. .Horm Metabolic Res 25::21. ,1993. .
-
27
Bamberger DM, Daus GP, Gerding DN: Osteomyelitis in the feet of diabetic patients: long-term results, prognostic factors, and the role of antimicrobial and surgical therapy. .Am J Med 83::653. ,1987. .
The Diagnosis of Osteomyelitis in Diabetes Using Erythrocyte Sedimentation Rate
A Pilot Study
Search for other papers by Jennifer L. Kaleta in
Current site
Google Scholar
PubMed
Search for other papers by Jeffrey W. Fleischli in
Current site
Google Scholar
PubMed
Search for other papers by Charles H. Reilly in
Current site
Google Scholar
PubMed
Osteomyelitis secondary to diabetic foot infections can lead to proximal amputation if not diagnosed in a timely and accurate manner. The authors have found no studies to date that correlate a specific erythrocyte sedimentation rate with osteomyelitis. A retrospective chart review of 29 diabetic patients admitted to the hospital with diagnoses of osteomyelitis or cellulitis of the foot during a 1-year period was performed. Of the various lab values and demographic factors compared, erythrocyte sedimentation rate was the only measure that differed significantly between the two groups. A receiver operating characteristic curve was used to obtain the optimal cutoff value of 70 mm/h, a level above which osteomyelitis was present with the highest sensitivity (89.5%) and highest specificity (100%), along with a positive predictive value of 100% and a negative predictive value of 83%. This study shows that in combination with clinical suspicion in diabetic foot infections, the erythrocyte sedimentation rate is highly predictive of osteomyelitis, and that the value of 70 mm/h is the optimal cutoff to predict accurately the presence or absence of bone infection. (J Am Podiatr Med Assoc 91(9): 445-450, 2001)
advertising
