MAKING THE DIAGNOSIS OF OSTEOMYELITIS - THE ROLE OF PREVALENCE

Clinicians may have poor sensitivity in determining whether a given di abetic patient with a foot ulcer has osteomyelitis. Thus many turn to diagnostic tests. The literature was reviewed and data on the sensitiv ity and specificity of five commonly used diagnostic tests were compil ed. Using Bayes' theorem, the authors' analysis suggests that pretest probability may be more important in the decision-making process than individual test characteristics. Also, a positive probe-to-bone test i s as predictive of osteomyelitis as the other four tests. A negative m agnetic resonance imaging test most likely rules out osteomyelitis. In terpretation of any test result is greatly influenced by the pretest p robability of disease. Future work needs to focus on aiding the clinic ian in determining the patient's probability of disease prior to testi ng in order to optimize patient care.