• 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. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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. .

    • Search Google Scholar
    • Export Citation
  • 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. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 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. .

    • Search Google Scholar
    • Export Citation
  • 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. .

    • PubMed
    • Search Google Scholar
    • Export Citation

The Diagnosis of Osteomyelitis in Diabetes Using Erythrocyte Sedimentation Rate

A Pilot Study

View More View Less
  • 1 Submitted as Chief Resident, Illinois Masonic Medical Center, 3000 N Halsted, Ste 500, Chicago, IL 60657.
  • | 2 Submitted during first-year residency, Illinois Masonic Medical Center, Chicago, IL.
  • | 3 Submitted as Residency Director, Illinois Masonic Medical Center, Chicago, IL.
Restricted access

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)