CLINICAL AND RADIOGRAPHIC FINDINGS THAT LEAD TO INTERVENTION IN DIABETIC-PATIENTS WITH FOOT ULCERS - A NATIONWIDE SURVEY OF PRIMARY-CARE PHYSICIANS

OBJECTIVE - To determine which elements of clinical history, physical examination, and diagnostic tests are important to primary care physic ians in their management of foot ulcers in diabetic patients. RESEARCH DESIGN AND METHODS - We conducted a national mail survey of 600 prima ry care physicians to determine which patient characteristics and diag nostic test results were important in their decisions to seek radiogra phic studies, surgical referrals, and hospitalization for diabetic pat ients with foot ulcers. RESULTS - The case characteristics most likely to influence physicians to order advanced diagnostic or therapeutic i nterventions are the presence of osteomyelitis on plain radiographs, t he failure of the ulcer to improve with conservative therapy, and the presence of visible bone, crepitus, or necrosis within the ulcer (P < 0.001). Information from the initial clinical history was less likely to influence physicians to order advanced diagnostic or therapeutic in terventions (P < 0.001) than was information from the physical examina tion. CONCLUSIONS - We conclude that 1) the patient's history is relat ively unimportant to primary care physicians in their management of di abetic foot ulcers; 2) the failure of conservative management is a maj or reason that primary care physicians order surgical referral, hospit alization, or radiographic testing for diabetic patients with foot ulc ers; and 3) primary care physicians rely heavily on plain X ray of the foot, a test with poor sensitivity and specificity, in deciding wheth er to order further interventions for their diabetic patients with foo t ulcers.