In their article, Darouiche et al1 report that pathologic evaluation of bone tissue is required for definitive diagnosis of osteomyelitis associated with pressure sores. They conclude that correct diagnosis by their method led to prolonged treatment and healing. While I would be delighted with a relatively safe and effective method to evaluate such cases, there is no evidence here that outcome was impacted at all. Unfortunately, the treatment arm was not randomized, nor are we told of the treatment strategies and outcomes of patients not thought to have osteomyelitis. Does the finding of inflammatory cells in the bone biopsy specimen affect outcome when treatments are similar? This is an interesting approach to a distressingly common problem. An outcomes trial is needed, and I hope it is undertaken by this group.