Early diagnosis of craniofacial necrotising fasciitis: Analysis of clinical risk factors

Abstract

Necrotising fasciitis (NF) is a rapidly progressing fatal disease. Craniofacial necrotising fasciitis (CNF) is limited to the region above the mandibular margin, and early diagnosis is particularly difficult in the absence of related studies. Ten‐year data of patients with craniofacial infection were collected from four separate hospitals. Based on the diagnostic criteria, patients were classified into abscess and CNF. The risk factors for early diagnosis were analysed by comparing the two groups. Simple abscess was found in 176 patients, and CNF was detected in 25 patients. The risk factors associated with CNF include old age, presence of odontogenic infection, elevated white blood cell count (WBC), increased C‐reactive protein (CRP), high levels of creatinine (Cr) and glucose (Glu) and low levels of haemoglobin (Hb) and albumin (Alb). In addition, fever above 38°C and sinusitis at the time of admission and progressive sepsis after admission were also risk factors. Among the statistically significant risk factors, low Alb level showed the greatest association with CNF progression. Appropriate management of CNF via early diagnosis and extensive surgical intervention based on identified risk factors can reduce the mortality rate, complications and unnecessary medical expenses. Clinical question/level of evidence: Diagnostic, III.

Application of the laboratory risk indicator for necrotizing fasciitis score to the head and neck: a systematic review and meta‐analysis

“…We calculated the diagnostic accuracy (i.e., diagnostic odds ratio [DOR]) and created a summary receiver operating characteristic (SROC) curve to calculate the area under the curve (AUC). 3,5,9,14,15,[18][19][20][21] The DORs were calculated as (true positives  true negatives)/(false positives  false negatives), with 95% confidence intervals (CIs) using a random effect model taking into account both intrastudy and interstudy variations. DORs range from 0 to infinity, with high values indicating better diagnostic performance, and a value of 1 indicating that the presence of disease cannot be inferred.…”

A Case Report of Necrotizing Fasciitis of the Neck and Anterior Chest Wall Caused by Odontogenic Infection in Elderly: Diagnosis and Management in Rural Area

“…Age in older than 60 year or younger than 1 year are at a high risk of mortalities. Our patient age is 65 years old 17,18 .…”

Secondary craniofacial necrotizing fasciitis from a distant septic emboli: A case report

“…The LRINEC score has been proven useful for detecting severe infections of the upper and lower extremities, which has improved the efficiency of the early diagnosis[ 13 ]. Some reports have shown that lower albumin levels in patients are associated with a more fatal prognosis[ 9 , 14 ]. Procalcitonin is synthesized in various tissues and organs in response to bacterial, fungal, and parasitic infections, and it has become a useful marker for determining whether antibiotics should be used for the duration of treatment[ 15 ].…”

“…At the time of hospitalization, the glycated hemoglobin (HbA1C) level was elevated at 17.1, indicating uncontrolled diabetes. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system was used for proper diagnosis of necrotizing fasciitis[ 9 ]. Laboratory findings showed a high white blood cell (WBC) count (15170/μL; LRINEC score 1 point), a low hemoglobin level (10.5 g/dL; LRINEC score 2 points), an elevated high-sensitivity C-reactive protein (hs-CRP) level (212.94 mg/L; LRINEC score 4 points), a high glucose level (242 mg/dL; LRINEC score 1 point), and a slightly low sodium level (134 mmol/L; LRINEC score 2 points).…”

“…The following results were normal: Creatinine, bilirubin, aspartate aminotransferase, and alanine aminotransferase. The patient had a score of 10 points in the LRINEC, indicating a high risk of CNF[ 9 ]. In addition, the albumin level was low at 2.3 g/dL.…”