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Emerg Med Australas. 2011 Jun;23(3):317-30. doi: 10.1111/j.1742-6723.2011.01413.x. Epub 2011 Apr 4.

How useful are laboratory investigations in the emergency department evaluation of possible osteomyelitis?

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  • 1Emergency Department, Timaru Public Hospital, Timaru, New Zealand.


We conducted a literature review to determine which laboratory investigations are useful for the ED evaluation of osteomyelitis. Thirty-six relevant papers were identified. We concluded that in adult and paediatric patients with a clinically low level of suspicion of osteomyelitis, an age-adjusted normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) <5 mg/L should reassure the clinician that no further urgent investigation is required. For patients with risk factors for osteomyelitis or a clinically high level of suspicion, a normal ESR or CRP <5 mg/L should not rule out the diagnosis of osteomyelitis, especially in patients with puncture wounds or foot ulcers/infections. In patients with any suspicion of osteomyelitis and otherwise unexplained ESR >30 mm/h and/or CRP >10-30 mg/L further definitive investigation is required. The white blood count is not helpful in the evaluation of osteomyelitis.

© 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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