Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

    Disease

    Select...

    Specialty

    Select...

    Chief Complaint

    Select...

    Organ System

    Select...

    Patent Pending

    LRINEC Score for Necrotizing Soft Tissue Infection

    Screens for necrotizing soft tissue infections.
    Favorite

    INSTRUCTIONS

    If high suspicion for necrotizing fasciitis through clinical history and physical exam, do not calculate a LRINEC score and go straight to operative debridement.
    Note: Use with caution, as the LRINEC Score has performed poorly in external validation, most recently in Neeki 2017.
    When to Use
    Pearls/Pitfalls
    Why Use
    • Patient with a concerning history or physical exam (pain out of proportion to exam, rapidly progressive cellulitis, for example).
    • Patient with an unconcerning story (can provide some reassurance if score is very low).
    • The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score was developed to distinguish necrotizing fasciitis (nec fasc) from severe cellulitis or abscess.
    • Retrospective observational study divided into a developmental cohort and a validation cohort.
    • Included 145 patients with necrotizing fasciitis and 309 patients with severe cellulitis or abscesses admitted to Changi General Hospital.
    • Developmental cohort consisted of 89 patients with nec fasc and 225 control patients.
    • Necrotizing fasciitis defined as operative exploration finding: presence of grayish necrotic fascia, lack of resistance of normally adherent muscular fascia to blunt dissection, lack of bleeding of the fascia during dissection, and the presence of foul-smelling “dishwater” pus.
    • From developmental cohort, authors derived scoring system of six criteria, each worth 0, 1, 2 or 4 points.
    • Score was then “externally validated” on a separate cohort of 56 consecutive patients with nec fasc and 84 control patients with severe cellulitis or abscess seen at Singapore General Hospital during a similar time frame.
    • Patients were classified into three groups: low (LRINEC score ≤5, <50% risk for nec fasc), moderate (LRINEC score 6-7, 50-75% risk for nec fasc), and high risk (LRINEC ≥8, >75% risk for nec fasc).
    • Using LRINEC ≥6 as a cut-off for nec fasc yielded PPV of 92% and NPV of 96%. ~90% of patients with nec fasc had LRINEC ≥ while only 3.1-8.4% of control patients had score ≥6.

    Points to keep in mind:

    • 10% of patients with nec fasc still had a LRINEC score <6.
    • There have been no prospective trials validating the LRINEC score.
    • Subsequent validation studies have not replicated the numbers shown in the original study.

    The score may be helpful in providing an overall gestalt picture of a patient with a potential necrotizing soft tissue infection -- but it cannot rule out this infection.

    <15 mg/dL (150 mg/L)
    0
    ≥15 mg/dL (150 mg/L)
    +4
    <15
    0
    15-25
    +1
    >25
    +2
    >13.5
    0
    11-13.5
    +1
    <11
    +2
    ≥135
    0
    <135
    +2
    ≤1.6 mg/dL (141 µmol/L)
    0
    >1.6 mg/dL (141 µmol/L)
    +2
    ≤180 mg/dL (10 mmol/L)
    0
    >180 mg/dL (10 mmol/L)
    +1

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    • All patients with a high clinical suspicion for necrotizing fasciitis should receive immediate surgical consultation for potential operative debridement.
    • Consider calculating a LRINEC score to distinguish patients with severe cellulitis/abscess vs necrotizing fasciitis.

    Management

    • Prompt fluid resuscitation and antibiotic administration are crucial in the treatment of necrotizing fasciitis.
    • Consider early surgical consultation in borderline cases.

    Critical Actions

    • A LRINEC score ≥6 is a reasonable cut-off to rule in necrotizing fasciitis, but a LRINEC <6 does not rule out the diagnosis.
    Content Contributors
    About the Creator
    Dr. Wong Chin Ho
    Are you Dr. Wong Chin Ho?
    Partner Content
    Content Contributors