802. Cost-Effective Evaluation of the Role of Serial Plain Radiographs in the Diagnosis of Diabetic Foot Osteomyelitis
Session: Poster Abstract Session: Bone and Joint
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • Poster X-ray_IDSA.pdf (1.3 MB)
  • Background: Nowadays, with the financial crisis, we examined whether plain radiograph (X/R), a low-cost examination (2,88 euros x2, for F+P), can provide a satisfactory substitute for MRI (cost: 236,95 euros)  in diagnosing diabetic foot osteomyelitis (OM). Costs are based on Greek National Health Insurance (EOPYY) prices.

    Methods: Retrospective study of all 439 diabetic Px that visited diabetic foot clinic for a 34-month period (15/11/2009 – 15/9/2012). According to our protocol, for all Px with PEDIS 3 or 4 infection and those with presumed PEDIS 2 with suspected OM (clinical criteria and/or positive probe-to-bone test) an X/R was ordered, and if there were no OM findings the X/R was repeated before antimicrobial treatment was discontinued.

    Results: 36 Px, age 39-85 yrs (26 men) had OM (diagnosed by X/R and/or MRI). X/R of the initial visit was positive for OM in 21/36 (sensitivity 59%), negative in 13, and suspicious in 1; in 1 Px X/R was not performed. X/R was repeated in 14/15 Px with negative/suspicious/not done initial X/R, and it was positive in 13/14. In the one Px with negative X/R, an MRI was asked because of strong OM suspicion, and this exam was positive. In 11/14 Px, X/R was repeated before antimicrobial therapy (given for SSTIs) was discontinued, and thus treatment could be continued following OM protocols. There were only 3 Px that X/R was repeated after treatment was discontinued. Of course, the possibility that OM occurred at a later time during disease course cannot be ruled out. Another Px (not belonging to the 36 with OM) had falsely suspicious X/R (an MRI ordered was normal). We performed MRI in only 7/36 patients with suspected OM, mostly to diagnose potential complications.

    Conclusion: Follow-up of suspected diabetic foot OM with serial plain radiographs has moderate sensitivity at the initial visit, but the sensitivity increases substantially in repeated radiographs (positive in our 34/36 Px with OM), while the cost is very reasonable. In cases of suspected OM and normal initial X/R, the X/R must be repeated while Px is still on antibiotic therapy. If normal again and OM suspicion index is high, an MRI must be ordered. This diagnostic approach can only be implicated if Px long-time follow-up is guaranteed, and in collaboration with an experienced radiologist.

    Chariclia Loupa, MD1, Eleftherios Koutsantoniou2, Eleftherios Voyatzoglou1, Emmanuel Papadakis2, Andriana Donou1, Stavroula Christaki1 and Sofia Lafoyanni2, (1)Demetrios Voyatzoglou Diabetic Foot Clinic, A. Fleming General Hospital, Athens, Greece, (2)Dept. of Radiology, A. Fleming General Hospital, Athens, Greece


    C. Loupa, None

    E. Koutsantoniou, None

    E. Voyatzoglou, None

    E. Papadakis, None

    A. Donou, None

    S. Christaki, None

    S. Lafoyanni, None

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