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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)

Category

Post-test probability of osteomyelitis

Management advice

Criteria

Definite

> 90%

Treat for osteomyelitis

Bone 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

Probable

51–90%

Consider treating

Visible 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

Possible

10–50%

Treatment may be justified, but further investigation usually advised

Plain 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 treatment

No 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