Validation of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for early diagnosis of necrotizing fasciitis
| Autor: | Chun-Hing Wong, Chin-Hsiang Chuang, Chun-I Liao, Yi-Kung Lee, Yung-Cheng Su |
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| Rok vydání: | 2012 |
| Předmět: |
Medicine(all)
medicine.medical_specialty Necrotizing soft tissue infection business.industry Necrotizing fasciitis General Medicine Emergency department Patient data medicine.disease Surgery Laboratory risk indicator for necrotizing fasciitis (LRINEC) Risk indicator Cellulitis Internal medicine medicine Surgical emergency Medical diagnosis business Fasciitis Pathological |
| Zdroj: | Tzu Chi Medical Journal. 24:73-76 |
| ISSN: | 1016-3190 |
| DOI: | 10.1016/j.tcmj.2012.02.009 |
| Popis: | Objective: Necrotizing fasciitis is a surgical emergency. It has a poor outcome after late operative intervention but the clinical diagnosis is difficult. The laboratory risk indicator for necrotizing fasciitis (LRINEC) score was first introduced in 2004 and several clinicians have suggested it is useful for early recognition of necrotizing fasciitis but its validation still needs to be examined. We collected our hospital data from May 2003 to September 2010 to validate whether the LRINEC score can aid in early recognition of necrotizing fasciitis. Materials and Methods: This is a validation cohort study. We reviewed all necrotizing fasciitis patients admitted from the emergency department at Buddhist Tzu Chi Dalin General Hospital in Taiwan from May 2003 to September 2010. All patients had pathological diagnoses. We used multiple imputations for missing patient data. We analyzed these data and examined whether the LRINEC score had a higher diagnostic value than the clinical diagnosis before admission. We also examined the LRINEC score in patients with severe cellulitis to determine its usefulness in excluding necrotizing fasciitis. Results: A total of 233 patients with necrotizing fasciitis and 3155 with severe cellulitis were included in our study. A LRINEC score � 6 had a sensitivity of 59.2% (CI 52.9e65.6%), specificity of 83.8% (CI 81.9 e85.7%), likelihood ratio of 3.89, positive predictive ratio of 37.9% (95% CI 32.9e42.9%), and negative predictive ratio of 92.5% (95% CI 91.0e94.0%). The rate of clinical diagnosis of necrotizing fasciitis by emergency physicians before admission was 58.4% (95% CI 52.0e64.8%). Of the 97 patients with necrotizing fasciitis who were not clinically diagnosed before admission, 43.3% (95% CI 36.9e49.7%) had a LRINEC score |
| Databáze: | OpenAIRE |
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