{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T15:04:51Z","timestamp":1786460691144,"version":"build-2736575974"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Objective:<\/jats:title>\n The objective of this systematic review is to evaluate and compare the diagnostic accuracy of physical examination, foot imaging, and inflammatory marker tests for the diagnosis of diabetic foot osteomyelitis in adults.<\/jats:p>\n <\/jats:sec>\n \n Introduction:<\/jats:title>\n Diabetic foot osteomyelitis is a serious complication of diabetic foot ulcers, often leading to amputation, prolonged hospitalization, and increased mortality. Several diagnostic modalities, ranging from bedside examinations to advanced imaging and laboratory biomarkers, are available; however, their diagnostic performance varies widely in terms of accuracy, invasiveness, and cost.<\/jats:p>\n <\/jats:sec>\n \n Eligibility criteria:<\/jats:title>\n This review will include diagnostic accuracy studies evaluating adults with diabetes and suspected diabetic foot osteomyelitis, comparing index tests (clinical, lab, imaging) against a reference standard (biopsy or clinical follow-up).<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n A 3-step search strategy will be applied. We will search Cochrane Central, Scopus, MEDLINE, ProQuest, and OAISTER. Google Scholar and ProQuest will be searched for gray literature. Studies published from January 2000 to the present will be considered. Two independent reviewers will conduct title and abstract screening, retrieval of full-text studies, full-text review, study selection, data extraction, and risk of bias assessment. Estimates of the individual results will be visualized by coupled forest plots, and the variability of individual results will be visualized using cross-hairs plots. For each index test, a random-effects, bivariate beta-binomial model will be used to pool sensitivity and specificity. Heterogeneity will be assessed using Zhou and Dendukuri\u2019s bivariate extension of the\n I2<\/jats:italic>\n statistic. Publication bias will be investigated using Deeks\u2019 funnel plots. For subgroups of index tests that form networks, we will perform diagnostic test accuracy network meta-analysis using a bivariate beta-binomial random-effects arm-based model. Sensitivity and subgroup analyses will be performed. The certainty of evidence for each diagnostic comparison will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for diagnostic test accuracy.\n <\/jats:p>\n <\/jats:sec>\n \n Review registration:<\/jats:title>\n PROSPERO CRD420251085609<\/jats:p>\n <\/jats:sec>","DOI":"10.11124\/jbies-25-00321","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T07:00:08Z","timestamp":1779778808000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic accuracy of tests for diabetic foot osteomyelitis: a Bayesian network meta-analysis protocol"],"prefix":"10.11124","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6903-5836","authenticated-orcid":false,"given":"Malavika","family":"Krishnakumar","sequence":"first","affiliation":[{"name":"Department of Health Sciences Research, Amrita Institute of Medical Sciences and Research Centre, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8908-1544","authenticated-orcid":false,"given":"Agnetha","family":"Folestad","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9059-5700","authenticated-orcid":false,"given":"Vivek","family":"Lakshmanan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3428-8774","authenticated-orcid":false,"given":"Anandakrishnan","family":"Nandakumar","sequence":"additional","affiliation":[{"name":"Department of Hospital Administration, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1098-9900","authenticated-orcid":false,"given":"Dipu T","family":"Sathyapalan","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5358-4391","authenticated-orcid":false,"given":"Vineetha","family":"Karuveettil","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham"},{"name":"JBI Amrita Centre for Evidence-Based Oral Health, Ernakulam, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1907-8708","authenticated-orcid":false,"given":"Chandrashekar","family":"Janakiram","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham"},{"name":"JBI Amrita Centre for Evidence-Based Oral Health, Ernakulam, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1925-8349","authenticated-orcid":false,"given":"Georg","family":"Gutjahr","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research, Amrita Institute of Medical Sciences and Research Centre, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 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