Written by Alex Chen, MD
In this systematic review and meta-analysis, no single aspect of the physical examination, imaging, or LRINEC score had high enough sensitivity to exclude necrotizing soft tissue infections. Contrast CT performed the best, but it was only 94.3% sensitive. If you have a high clinical suspicion, early surgical consultation is necessary for definitive diagnosis and management.
Why does this matter?
Necrotizing soft tissue infection (NSTI) is a time-sensitive condition with significant morbidity and mortality. Physical examination and conventional imaging are not sufficient to rule-out this diagnosis. While initially promising, the LRINEC score has performed poorly in external validation.
“My nec-fasc brings all the boys to the ER…”
Physical examination findings, plain radiography, and laboratory based scores (LRINEC) were unable to sufficiently rule-out NSTI. Even with the broader diagnostic criteria on a CT scan, the low-end of the 95% CI is 81.2%. While these elements are seldom used in isolation in the clinical context, the numbers aren’t particularly reassuring. Ultimately, this study suggests that nothing in isolation is enough to rule-out this disease and it would be prudent to get our surgical colleagues involved if we are concerned.
What Is the Accuracy of Physical Examination, Imaging, and the LRINEC Score for the Diagnosis of Necrotizing Soft Tissue Infection? Ann Emerg Med. 2018 Aug 13. pii: S0196-0644(18)30560-2. doi: 10.1016/j.annemergmed.2018.06.029. [Epub ahead of print]
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Reviewed by Clay Smith