Indexing Severity of Diabetic Foot Infection With ^sup 99m^Tc-WBC SPECT/CT Hybrid Imaging
- Autores: Alacoque Lorenzini Erdmann, William A. Erdman, Ji Buethe, Rafia Bhore, Hans K. Ghayee, Chiarra Thompson, Param Maewal, Jon Anderson, Steve Klemow, Orhan K. Oz
- Localización: Diabetes care, ISSN-e 0149-5992, Vol. 35, Nº. 9, 2012, págs. 1826-1831
- Idioma: inglés
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Resumen
Management of diabetic foot infection (DFI) has been hampered by limited means of accurately classifying disease severity. New hybrid nuclear/computed tomography (CT) imaging techniques elucidate a combination of wound infection parameters not previously evaluated as outcome prognosticators. Our aim is to determine if a novel standardized hybrid image-based scoring system, Composite Severity Index (CSI), has prognostic value in DFI. Masked retrospective ^sup 99m^Tc-white blood cell (WBC) single photon emission CT (SPECT)/CT image interpretation and independent chart review of 77 patients (101 feet) suspected of DFI-associated osteomyelitis at a large municipal hospital between January 2007 and July 2009. CSI scores were correlated with probability of favorable outcome (no subsequent amputation/readmission after therapeutic intervention) during median 342-day follow-up. CSI ranged from 0-13. Receiver operating characteristic accuracy for predicting favorable outcome was 0.79 (optimal cutoff CSI, ?2; odds ratio of therapeutic failure for CSI >2, 15.1 [95% CI 4.4-51.5]). CSI of 0 had a 92% chance of favorable outcome, which fell progressively to 25% as indices rose to ?7. Image-based osteomyelitis versus no osteomyelitis assessment was less accurate than CSI at predicting outcome (P = 0.016). In patients with intermediate severity (CSI 3-6), treatment failure decreased from 68 to 36% when antibiotic duration was extended to ?42 days (P = 0.026). ^sup 99m^Tc-WBC SPECT/CT hybrid image-derived wound infection parameters incorporated into a standardized scoring system, CSI, has prognostic value in DFI.
