Clinical Question: Which standard ...

Clinical Question: Which standard is most accurate in diagnosing chronic osteomyelitis?

Setting: Various (meta-analysis)

studious mood Design: Meta-analysis (randomized controlled trials)

Synopsis: researchers searched MEDLINE, EMBASE, and passing from hand to hand Contents for studies including at least 10 adults evaluated for chronic osteomyelitis with noninvasive diagnostic exhibitions (i.e., radiography, positron emission tomography [PET] leukocyte scintigraphy, bone scintigraphy, gallium scintigraphy, magnetic resonance imaging, or comput tomography) who also had histology, civilization results, or clinical follow-up. Because single in kind of the hallmarks of a beneficial diagnostic test is its ability to distinguish among similar conditions, it is noteworthy that they exclud studies that evaluated septic or aseptic loosening of prosthetic joints. The researchers barely included studies that provided enough detail to calculate the characteristics of the various diagnostic tests

pair reviewers independently determined study eligibility and extracted the data. Any discrepancies were settl from consensus. They also evaluated each study's methodologic quality onward six criteria. When they set up excessive variability in the data across studies, they did subgroup analyses to determine if the standards perform differently in axial and peripheral skeletal infections.

A total of 23 studies with 1269 patients were included. The methodologic quality was highly variable; nonetheless, the researchers pond ed the data for all studies. fondling compared with any other example was the most sensitive (96 percent) and specific (91 percent) This translates to a positive likelihood ratio of 107 (95% confidence interval [CI], 46 to 198) and a negative likelihood ratio of 004 (95% CI, 001 to 015) more [i]or[/i] less combinations of tests (i.e., bone scintigraphy plus leukocyte scintigraphy or bone scintigraphy plus gallium scintigraphy) had comparable sensitivity. These estimates are likely to be biased because poor-quality studies were included.

Bottom Line: fondling is the most accurate experiment to diagnose chronic osteomyelitis. (Level of Evidence: 3a)

HENRY BARRY, MD MS

thought Reference: Termaat MF, et al. The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis. J Bone Joint Surg Am November 2005;87:2464-71

Used with permission from Barry H angry mood scan best in chronic osteomyelitis diagnosis. Accessed online January 18 2006 at: http://www.InfoPOEMs.com.

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