Skip to main content

Table 1 Diagnostic criteria for DFO (adapted from Berendt et al., 2008 with permission)

From: A multicenter randomized placebo controlled trial of rifampin to reduce pedal amputations for osteomyelitis in veterans with diabetes (VA INTREPID)

CategoryPost-test probability of osteomyelitisManagement adviceCriteria
Definite> 90%Treat for osteomyelitisBone sample with positive culture AND
positive histology OR
Purulence in bone found at surgery OR
Atraumatically detached bone fragment removed from ulcer by podiatrist/surgeon OR
Intraosseous abscess on MRI OR
Any two probable criteria OR one probable and two possible criteria OR any four possible criteria below
Probable51–90%Consider treatingVisible cancellous bone in ulcer OR
MRI showing bone edema with other signs of osteomyelitis OR
Bone sample with positive culture but negative or absent histology OR
Bone sample with positive histology but negative or absent culture OR
Any two possible criteria below
Possible10–50%Treatment may be justified, but further investigation usually advisedPlain X-rays show cortical destruction OR
MRI shows bone edema or cloaca OR
Probe to bone positive or visible cortical bone OR
ESR > 70 mm/hr. with no other plausible explanation OR
Non-healing wound despite adequate offloading and perfusion for >6 weeks or ulcer of >2 weeks duration with clinical evidence of infection
Unlikely< 10%Usually no need for further investigation or treatmentNo signs or symptoms of inflammation AND normal X-rays AND ulcer present for <2 weeks or absent AND any ulcer present is superficial OR
Normal MRI OR Normal bone scan