This JAMA Rational Clinical Examination systematic review asks: which bedside findings, labs, and imaging tests best diagnose lower extremity osteomyelitis in diabetic patients? It synthesizes 21 studies (1,027 patients) and a separate MRI meta-analysis to provide likelihood ratios for each diagnostic modality.
When you see a diabetic foot ulcer, use probe-to-bone and ulcer size to stratify risk at the bedside — if either is positive alongside ESR >70, treat for osteomyelitis or proceed to MRI for confirmation.
Reserve MRI primarily for cases where you need to rule out the diagnosis: a negative MRI in a low-to-moderate pretest probability patient is the only finding that reliably brings the probability below 3%.
This JAMA Rational Clinical Examination systematic review asks: which bedside findings, labs, and imaging tests best diagnose lower extremity osteomyelitis in diabetic patients? It synthesizes 21 studies (1,027 patients) and a separate MRI meta-analysis to provide likelihood ratios for each diagnostic modality.
When you see a diabetic foot ulcer, use probe-to-bone and ulcer size to stratify risk at the bedside — if either is positive alongside ESR >70, treat for osteomyelitis or proceed to MRI for confirmation.
Reserve MRI primarily for cases where you need to rule out the diagnosis: a negative MRI in a low-to-moderate pretest probability patient is the only finding that reliably brings the probability below 3%.