Calvo-Wright María Del Mar, Álvaro-Afonso Francisco Javier, López-Moral Mateo, García-Álvarez Yolanda, García-Morales Esther, Lázaro-Martínez José Luis
Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia and Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
J Clin Med. 2023 Aug 18;12(16):5369. doi: 10.3390/jcm12165369.
A systematic review and meta-analysis was conducted to assess the diagnostic accuracy of the combination of plain X-ray and probe-to-bone (PTB) test for diagnosing diabetic foot osteomyelitis (DFO). This systematic review has been registered in PROSPERO (a prospective international register of systematic reviews; identification code CRD42023436757). A literature search was conducted for each test separately along with a third search for their combination. A total of 18 articles were found and divided into three groups for separate analysis and comparison. All selected studies were evaluated using STROBE guidelines to assess the quality of reporting for observational studies. Meta-DiSc software was used to analyze the collected data. Concerning the diagnostic accuracy variables for each case, the pooled sensitivity (SEN) was higher for the combination of PTB and plain X-ray [0.94 (PTB + X-ray) vs. 0.91 (PTB) vs. 0.76 (X-ray)], as was the diagnostic odds ratio (DOR) (82.212 (PTB + X-ray) vs. 57.444 (PTB) vs. 4.897 (X-ray)). The specificity (SPE) and positive likelihood ratio (LR+) were equally satisfactory for the diagnostic combination but somewhat lower than for PTB alone (SPE: 0.83 (PTB + X-ray) vs. 0.86 (PTB) vs. 0.76 (X-ray); LR+: 5.684 (PTB + X-ray) vs. 6.344 (PTB) vs. 1.969 (X-ray)). The combination of PTB and plain X-ray showed high diagnostic accuracy comparable to that of MRI and histopathology diagnosis (the gold standard), so it could be considered useful for the diagnosis of DFO. In addition, this diagnostic combination is accessible and inexpensive but requires training and experience to correctly interpret the results. Therefore, recommendations for this technique should be included in the context of specialized units with a high prevalence of DFO.
进行了一项系统评价和荟萃分析，以评估普通X线与探骨（PTB）试验联合诊断糖尿病足骨髓炎（DFO）的诊断准确性。该系统评价已在PROSPERO（一个前瞻性国际系统评价注册库；识别码CRD42023436757）中注册。分别对每项检查进行文献检索，并对两者的联合进行第三次检索。共找到18篇文章，并分为三组进行单独分析和比较。所有选定的研究均使用STROBE指南进行评估，以评估观察性研究的报告质量。使用Meta-DiSc软件分析收集的数据。关于每个病例的诊断准确性变量，PTB与普通X线联合的合并敏感度（SEN）更高[0.94（PTB+X线）vs.0.91（PTB）vs.0.76（X线）]，诊断比值比（DOR）也是如此（82.212（PTB+X线）vs.57.444（PTB）vs.4.897（X线））。诊断联合的特异度（SPE）和阳性似然比（LR+）同样令人满意，但略低于单独使用PTB（SPE：0.83（PTB+X线）vs.0.86（PTB）vs.0.76（X线）；LR+：5.684（PTB+X线）vs.6.344（PTB）vs.1.969（X线））。PTB与普通X线联合显示出与MRI和组织病理学诊断（金标准）相当的高诊断准确性，因此可认为对DFO的诊断有用。此外，这种诊断联合方法易于获得且成本低廉，但需要培训和经验来正确解读结果。因此，应在DFO高发的专科单位背景下纳入对该技术的推荐。
