Title : A retrospective audit into the imaging practices for diabetic foot infections
Abstract:
Introduction: MRI is currently the investigative modality of choice for diabetic foot infections (DFIs). Our trust guidelines recommend an MRI in all moderate and severe DFIs and in other cases based on clinical judgement. This has led to non-uniform use of MRI. Our audit provides a snapshot into the current practices of imaging (X-ray and MRI) in DFI and the outcomes.
Methods: A retrospective review of 130 DFI patients from 2021 to 2024 was conducted; 114 were included after excluding cases with MRI contraindications and patient refusals. The following variables were studied: Initial X-Ray, Initial MRI scan, Repeat MRI scan, change in antibiotic following repeat MRI, Clinical outcomes.
Results: Initial MRI was performed only in 18% of severe DFIs, 61.7% of moderate DFIs and also in 28.5% of mild DFIs. MRI was repeated in 54.5% of moderate DFIs, with no clear reasoning documented. Significant re-admission rates were noted across the board-62% in mild, 48% in moderate, and 58% in severe. High amputation rates were seen (28% in mild, 22% in moderate, and 41% in severe), even in mild disease. Our current findings emphasize the existing gap between current practice and clinical guidelines.
First action plan:
- Present findings at Radiology and T&O Quash
- Introduction of a diabetic foot MDT proforma to allow for clear documentation as to the management plan for patients with DFI
- Re-audit to assess whether the introduction of a proforma provides more information on MRI usage.
