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    Patent Pending

    LRINEC Score for Necrotizing Soft Tissue Infection

    Screens for necrotizing soft tissue infections.

    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:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Wong Chin Ho

    About the Creator

    Wong Chin Ho, MD, is a plastic surgeon accredited by the Ministry of Health of Singapore and head of W Aesthetic Plastic Surgery. He complete advanced surgical training at the Department of Plastic Reconstructive and Aesthetic Surgery at Singapore General Hospital. Dr. Wong is actively involved in clinical research with interests in facial anatomy, anatomical changes of the aging face and aesthetic surgery.

    To view Dr. Wong Chin Ho's publications, visit PubMed

    Are you Dr. Wong Chin Ho? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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