Probe-to-bone test for diagnosing diabetic foot osteomyelitis: Reliable or relic?

Lawrence A. Lavery, David G Armstrong, Edgar J G Peters, Benjamin A. Lipsky

Research output: Contribution to journalArticle

166 Citations (Scopus)

Abstract

OBJECTIVE - We sought to assess the accuracy of the probe-to-bone (PTB) test in diagnosing foot osteomyelitis in a cohort of diabetic patients with bone culture proven disease. RESEARCH DESIGN AND METHODS - In this 2-year longitudinal cohort study, we enrolled 1,666 consecutive diabetic individuals who underwent an initial standardized detailed foot assessment, followed by examinations at regular intervals. Patients were instructed to immediately come to the foot clinic if they developed a lower-extremity complication. For all patients with a lower-extremity wound, we compared the results of the PTB test with those of a culture of the affected bone. We called PTB positive if the bone or joint was palpable and defined osteomyelitis as a positive bone culture. RESULTS - Over a mean of 27.2 months of follow-up, 247 patients developed a foot wound and 151 developed 199 foot infections. Osteomyelitis was found in 30 patients: 12% of those with a foot wound and 20% in those with a foot infection. When all wounds were considered, the PTB test was highly sensitive (0.87) and specific (0.91); the positive predictive value was only 0.57, but the negative predictive value was 0.98. CONCLUSIONS - The PTB test, when used in a population of diabetic patients with a foot wound among whom the prevalence of osteomyelitis was 12%, had a relatively low positive predictive value, but a negative test may exclude the diagnosis.

Original languageEnglish (US)
Pages (from-to)270-274
Number of pages5
JournalDiabetes Care
Volume30
Issue number2
DOIs
StatePublished - Feb 2007
Externally publishedYes

Fingerprint

Diabetic Foot
Osteomyelitis
Foot
Bone and Bones
Wounds and Injuries
Lower Extremity
Infection
Longitudinal Studies
Cohort Studies
Research Design
Joints

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Probe-to-bone test for diagnosing diabetic foot osteomyelitis : Reliable or relic? / Lavery, Lawrence A.; Armstrong, David G; Peters, Edgar J G; Lipsky, Benjamin A.

In: Diabetes Care, Vol. 30, No. 2, 02.2007, p. 270-274.

Research output: Contribution to journalArticle

Lavery, Lawrence A. ; Armstrong, David G ; Peters, Edgar J G ; Lipsky, Benjamin A. / Probe-to-bone test for diagnosing diabetic foot osteomyelitis : Reliable or relic?. In: Diabetes Care. 2007 ; Vol. 30, No. 2. pp. 270-274.
@article{78acd5b8391643da8c91538c01d85410,
title = "Probe-to-bone test for diagnosing diabetic foot osteomyelitis: Reliable or relic?",
abstract = "OBJECTIVE - We sought to assess the accuracy of the probe-to-bone (PTB) test in diagnosing foot osteomyelitis in a cohort of diabetic patients with bone culture proven disease. RESEARCH DESIGN AND METHODS - In this 2-year longitudinal cohort study, we enrolled 1,666 consecutive diabetic individuals who underwent an initial standardized detailed foot assessment, followed by examinations at regular intervals. Patients were instructed to immediately come to the foot clinic if they developed a lower-extremity complication. For all patients with a lower-extremity wound, we compared the results of the PTB test with those of a culture of the affected bone. We called PTB positive if the bone or joint was palpable and defined osteomyelitis as a positive bone culture. RESULTS - Over a mean of 27.2 months of follow-up, 247 patients developed a foot wound and 151 developed 199 foot infections. Osteomyelitis was found in 30 patients: 12{\%} of those with a foot wound and 20{\%} in those with a foot infection. When all wounds were considered, the PTB test was highly sensitive (0.87) and specific (0.91); the positive predictive value was only 0.57, but the negative predictive value was 0.98. CONCLUSIONS - The PTB test, when used in a population of diabetic patients with a foot wound among whom the prevalence of osteomyelitis was 12{\%}, had a relatively low positive predictive value, but a negative test may exclude the diagnosis.",
author = "Lavery, {Lawrence A.} and Armstrong, {David G} and Peters, {Edgar J G} and Lipsky, {Benjamin A.}",
year = "2007",
month = "2",
doi = "10.2337/dc06-1572",
language = "English (US)",
volume = "30",
pages = "270--274",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "2",

}

TY - JOUR

T1 - Probe-to-bone test for diagnosing diabetic foot osteomyelitis

T2 - Reliable or relic?

AU - Lavery, Lawrence A.

AU - Armstrong, David G

AU - Peters, Edgar J G

AU - Lipsky, Benjamin A.

PY - 2007/2

Y1 - 2007/2

N2 - OBJECTIVE - We sought to assess the accuracy of the probe-to-bone (PTB) test in diagnosing foot osteomyelitis in a cohort of diabetic patients with bone culture proven disease. RESEARCH DESIGN AND METHODS - In this 2-year longitudinal cohort study, we enrolled 1,666 consecutive diabetic individuals who underwent an initial standardized detailed foot assessment, followed by examinations at regular intervals. Patients were instructed to immediately come to the foot clinic if they developed a lower-extremity complication. For all patients with a lower-extremity wound, we compared the results of the PTB test with those of a culture of the affected bone. We called PTB positive if the bone or joint was palpable and defined osteomyelitis as a positive bone culture. RESULTS - Over a mean of 27.2 months of follow-up, 247 patients developed a foot wound and 151 developed 199 foot infections. Osteomyelitis was found in 30 patients: 12% of those with a foot wound and 20% in those with a foot infection. When all wounds were considered, the PTB test was highly sensitive (0.87) and specific (0.91); the positive predictive value was only 0.57, but the negative predictive value was 0.98. CONCLUSIONS - The PTB test, when used in a population of diabetic patients with a foot wound among whom the prevalence of osteomyelitis was 12%, had a relatively low positive predictive value, but a negative test may exclude the diagnosis.

AB - OBJECTIVE - We sought to assess the accuracy of the probe-to-bone (PTB) test in diagnosing foot osteomyelitis in a cohort of diabetic patients with bone culture proven disease. RESEARCH DESIGN AND METHODS - In this 2-year longitudinal cohort study, we enrolled 1,666 consecutive diabetic individuals who underwent an initial standardized detailed foot assessment, followed by examinations at regular intervals. Patients were instructed to immediately come to the foot clinic if they developed a lower-extremity complication. For all patients with a lower-extremity wound, we compared the results of the PTB test with those of a culture of the affected bone. We called PTB positive if the bone or joint was palpable and defined osteomyelitis as a positive bone culture. RESULTS - Over a mean of 27.2 months of follow-up, 247 patients developed a foot wound and 151 developed 199 foot infections. Osteomyelitis was found in 30 patients: 12% of those with a foot wound and 20% in those with a foot infection. When all wounds were considered, the PTB test was highly sensitive (0.87) and specific (0.91); the positive predictive value was only 0.57, but the negative predictive value was 0.98. CONCLUSIONS - The PTB test, when used in a population of diabetic patients with a foot wound among whom the prevalence of osteomyelitis was 12%, had a relatively low positive predictive value, but a negative test may exclude the diagnosis.

UR - http://www.scopus.com/inward/record.url?scp=33846707887&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33846707887&partnerID=8YFLogxK

U2 - 10.2337/dc06-1572

DO - 10.2337/dc06-1572

M3 - Article

C2 - 17259493

AN - SCOPUS:33846707887

VL - 30

SP - 270

EP - 274

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 2

ER -