Does dermal thermometry predict clinical outcome in diabetic foot infection? Analysis of data from the SIDESTEP* trial

David G Armstrong, Benjamin A. Lipsky, Adam B. Polis, Murray A. Abramson

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

The purpose of the study was to assess in patients with a diabetic foot infection (DFI), whether differences in skin temperature of the affected foot as compared to the corresponding site on the contralateral foot using dermal thermometry (DT) correlates with infection severity and clinical outcome. As part of the SIDESTEP DFI study, investigators took DT measurements at baseline and the discontinuation of intravenous therapy (DCIV) and performed a systematic evaluation of the infected limb to calculate a wound score. We compared the skin temperature differential between the limbs at the two assessments and determined the correlation between this value and surrogate markers of inflammation and the clinical response to treatment. Among patients enrolled in SIDESTEP, 332 were fully evaluable. The mean temperature differential between the limbs was 2.81 ± 5.75°F at baseline and 2.43 ± 4.84°F at DCIV (mean change: -0.37; 95% confidence interval (CI): -0.98, 0.23; P = 0.225). Skin temperature differential at baseline did not correlate with white blood cell count, level of C-reactive protein or erythrocyte sedimentation rate or the infection severity score (r = 0.058, 0.148, -0.002, 0.067, respectively). We observed no overall trend between surface temperature differential at baseline and clinical outcome at DCIV, but patients with a skin temperature differential of ≥10°F at baseline had a significantly lower clinical response than those whose differential was <10°F (81.4% versus 94.3%; difference 12.9%; 95% CI: 3.5, 27.3%, P = 0.007). While there was no overall relationship between skin temperature and poor clinical outcome, there may be a threshold effect in DT (<10°F versus >10°F) between the limbs at baseline that predicts outcome of therapy.

Original languageEnglish (US)
JournalInternational Wound Journal
Volume3
Issue number4
DOIs
StatePublished - Dec 2006
Externally publishedYes

Fingerprint

Thermometry
Diabetic Foot
Skin Temperature
Extremities
Skin
Infection
Foot
Therapeutics
Temperature
Blood Sedimentation
Leukocyte Count
C-Reactive Protein
Biomarkers
Research Personnel
Confidence Intervals
Inflammation
Wounds and Injuries

Keywords

  • Clinical outcome
  • Dermal thermometry
  • Foot infection
  • Skin temperature

ASJC Scopus subject areas

  • Surgery

Cite this

Does dermal thermometry predict clinical outcome in diabetic foot infection? Analysis of data from the SIDESTEP* trial. / Armstrong, David G; Lipsky, Benjamin A.; Polis, Adam B.; Abramson, Murray A.

In: International Wound Journal, Vol. 3, No. 4, 12.2006.

Research output: Contribution to journalArticle

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abstract = "The purpose of the study was to assess in patients with a diabetic foot infection (DFI), whether differences in skin temperature of the affected foot as compared to the corresponding site on the contralateral foot using dermal thermometry (DT) correlates with infection severity and clinical outcome. As part of the SIDESTEP DFI study, investigators took DT measurements at baseline and the discontinuation of intravenous therapy (DCIV) and performed a systematic evaluation of the infected limb to calculate a wound score. We compared the skin temperature differential between the limbs at the two assessments and determined the correlation between this value and surrogate markers of inflammation and the clinical response to treatment. Among patients enrolled in SIDESTEP, 332 were fully evaluable. The mean temperature differential between the limbs was 2.81 ± 5.75°F at baseline and 2.43 ± 4.84°F at DCIV (mean change: -0.37; 95{\%} confidence interval (CI): -0.98, 0.23; P = 0.225). Skin temperature differential at baseline did not correlate with white blood cell count, level of C-reactive protein or erythrocyte sedimentation rate or the infection severity score (r = 0.058, 0.148, -0.002, 0.067, respectively). We observed no overall trend between surface temperature differential at baseline and clinical outcome at DCIV, but patients with a skin temperature differential of ≥10°F at baseline had a significantly lower clinical response than those whose differential was <10°F (81.4{\%} versus 94.3{\%}; difference 12.9{\%}; 95{\%} CI: 3.5, 27.3{\%}, P = 0.007). While there was no overall relationship between skin temperature and poor clinical outcome, there may be a threshold effect in DT (<10°F versus >10°F) between the limbs at baseline that predicts outcome of therapy.",
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