The appropriateness of X-ray referrals of osteomylelitis and its timely management with antibiotics: a service evaluation

Background: Osteomyelitis is a frequent occurrence in the high risk foot, which if not detected early and managed appropriately, can lead to severe complications for patients. Alongside the clinical signs and symptoms of infection, X-rays are the most commonly used tool to confirm diagnosis in practice. Aim: A service evaluation was conducted to ascertain whether clinicians are safely and appropriately referring patients for X-ray with suspected osteomyelitis, and whether suitable management is instigated at the point of clinical diagnosis. Method: X-ray cards which questioned the presence of osteomyelitis, requested between the period of April 2020 to April 2021, were reviewed within a community podiatry service in the NHS. Results: A total of 40 X-ray request cards were analysed, with 5% (n = 2) providing no clinical detail to rationalise referral, 45% (n = 18) outlining one reason, and 50% (n = 20) detailing more than one clinical detail to justify referral. The most common clinical finding to support referral was the presence of a chronic wound (n = 21, 53%). A total of 12 (30%) were confirmed to have osteomyelitis, a positive probe to bone test being found to be the most indicative rationale (n = 7, 64%). Only 10% (n = 4) had commenced bone penetrating antibiotics at the time of referral. Conclusion: Education and the development of guidance for clinicians within the community podiatry service is required to advance knowledge when assessing wounds for the presence of osteomyelitis and to promote timely instigation of antibiotics. This is necessary to improve the appropriateness and detail of X-ray referral requests to champion patient safety and enhance patient outcomes.