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Abdullah, M., et al. (2019). "Reliability of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) score." The Surgeon 17(5): 309-318 https://www.sciencedirect.com/science/article/pii/S1479666X18300933
Background The LRINEC score was introduced in 2004 but it has not yet been incorporated as a reliable diagnostic tool in the management of Necrotising Fasciitis. NF is uncommon and proportionately the evidence is limited, but the contradictory literature has resulted in varying individual concepts and clinical practices. This article is aimed to evaluate the reliability of the LRINEC score and determine its effectiveness based on the current available evidence. Methods Eighteen clinical studies published during 2004–2018 were identified after an extended literature search and critically appraised to determine the validity, reliability and applicability of the individual pieces of evidence. The recommendations for practice were formulated after summative analysis of the evidence. Results The systemic review and observational studies report the LRINEC score has a variable range of sensitivity (43.2–80%), positive predictive value (57–64%) and negative predictive value (42–86%) which is lower than the initial results by Wong et al. (2004). The LRINEC score ≥6 correlates well with diagnosis of NF but 7.1 was found to be statistically significant. Higher LRINEC score correlates with higher SOFA score, prolonged ICU and hospital stay, and mortality. It is not sensitive in immunocompromised patients. Conclusions There is Level 3 evidence that LRINEC score is a reliable tool which can aid the clinical diagnosis of NF. It can stratify the high-risk patients and predict outcome; however, it should be correlated with the clinical assessment and radiological diagnostic modalities should be simultaneously used when doubt exists (grade C).
Diab, J., et al. (2020). "Necrotising fasciitis." BMJ 369: m1428 https://www.bmj.com/content/bmj/369/bmj.m1428.full
A 36 year old indigenous Australian woman presents to her general practitioner with non-tender swelling on her flank and no other symptoms (including no fevers or chills). Her medical history includes type 2 diabetes mellitus, hypertension, dyslipidaemia, obesity, and chronic kidney disease. She is given oral antibiotics for presumed cellulitis but does not take them. Five days later, she presents to hospital with progressive generalised abdominal pain, soft tissue swelling, and fever. She is treated with broad spectrum antibiotics (meropenem, vancomycin, and clindamycin), fluid resuscitation, and electrolyte replacement. Her abdomen has several focuses of necrosis, generalised tenderness, and soft tissue induration extending to the bilateral subcostal margins (fig 1). She is taken urgently to theatre for aggressive surgical debridement and resuscitatio
Dr, A. G., et al. (2019). "Post-traumatic necrotising fasciitis of the breast: a case study with literature review." Journal of Wound Care 28(11): 775-778 https://www.magonlinelibrary.com/doi/abs/10.12968/jowc.2019.28.11.775
Necrotising fasciitis is a rare infection of the skin and underlying soft tissue. It primarily involves the extremities and rarely the breast. Primary necrotising fasciitis of the breast in a non-lactating, healthy female is rarer still. The authors present the case report of a patient presenting with primary necrotising fasciitis of the breast after sustaining a penetrating injury. The patient was managed successfully with serial debridement and negative pressure wound therapy (NPWT). To our knowledge only 19 such cases have been reported in the indexed literature so far. This is also the eighth case globally of primary necrotising fasciitis of the breast in a non-lactating female without any associated immunosuppression, which is the basis of reporting this case.
Nguyen, Q. D., et al. (2022). "The impact of COVID-19 on delayed presentations of necrotising fasciitis." Journal of Surgical Case Reports 2022(2) https://doi.org/10.1093/jscr/rjac015
The purpose of this study was to determine the impact of coronavirus disease 2019 (COVID-19) on the delayed presentation of necrotising fasciitis (NF). A retrospective study was conducted of adult patients (≥16 years old) diagnosed with NF at a hospital from 2017 to 2020. A quantitative comparative analysis for the COVID-19 group and control group between 2017 and 2019. Structured interviews were conducted to examine the impact of COVID-19 on patients. There were 6 patients in the COVID-19 group and 10 patients in the control group. The COVID-19 group had a longer mean onset of symptoms till hospital presentation of 4.1 days and a longer mean operative time. The COVID-19 group was more likely to be admitted to intensive care unit. Three patients in the COVID-19 group did not survive compared to survival in the counterparts. Participant responses indicated the COVID-19 pandemic did not prevent them from presenting to ED.
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