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Journal of the American Podiatric Medical Association Volume 91 Number 9 445-450 2001
Copyright © 2001 American Podiatric Medical Association

The Diagnosis of Osteomyelitis in Diabetes Using Erythrocyte Sedimentation Rate

A Pilot Study

Jennifer L. Kaleta, DPM*, Jeffrey W. Fleischli, DPM{dagger} and Charles H. Reilly, DPM{ddagger}

* Submitted as Chief Resident, Illinois Masonic Medical Center, 3000 N Halsted, Ste 500, Chicago, IL 60657.
{dagger} Submitted during first-year residency, Illinois Masonic Medical Center, Chicago, IL.
{ddagger} Submitted as Residency Director, Illinois Masonic Medical Center, Chicago, IL.

Abstract

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)




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