Kathryn: You have seen no activity on this question yet … because, (in my opinion) it’s a chicken and egg question. To start, I’d like more information on ‘why’ the CMO would be asking that question. I need to know the motivation of the question before positing some sort of answer. I’d hate to answer a question that wasn’t really asked.
And, I’d like to answer this question with another question to pose to the CMO. Consider a patient with a suspected osteomyelitis. This first test is ALWAYS a plain x-ray of the affected area along with 2 non-specific laboratory tests — C-reactive protein and sedimentation rate. We all know that this is the most unlikely to show any lytic bone activity, but we must start here (primarily b/c in my state, Medicaid requires it … as in the ABI/TBI). Then, the next step in an osteomyelitis workup is an MRI — frequently not providing much more information than an x-ray. But, this workup is considered standard of care.
Next, comes some sort of tagged white cell nuclear medicine scan. May/may not be helpful to isolate osteomyelitis. And, finally comes an open bone biopsy with debridement, cultures, etc. etc.
After all of this, we ask the opinion of our infectious disease specialist and get the same answer as if we hadn’t done any of the above tests … six weeks of ‘appropriate’ bone-penetrating antibiotics and observe for recurrence. .
The exact same reasoning that we get ABI/TBI … it’s a requirement and standard of care. Overall, the results do help us in patient management. However, more often than not, these results are simply standard of care, and are interpreted along with laser Doppler, MRA, and frequently invasive vascular interventions. I guarantee you that no surgeon would start invasive vascular intervention without performing an ABI/TBI first.
So, I really don’t mind if you print out my response for the CMO. I’m intrigued about the motivation behind the question. In all my years in practice, I don’t think that this has ever come up with the CMO. Well, it has but only because the CMO was one of my wound/HBO clinic physicians … (chuckle, chuckle) …
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