Necrotizing Fasciitis: Improved Survival With Early Recognition by Tissue Biopsy and Aggressive Surgical Treatment

Majeski, James; Majeski, Elizabeth I.

doi:10.1097/00007611-199711000-00001

Cited by 195 publications

(149 citation statements)

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“…Majeski and co-workers also reported a similar profile of predisposing risk factors [13]. Both these conditions are associated with a progressive decrease in immunity, which may be responsible for the infections in the tissue planes.…”

Section: Discussionmentioning

confidence: 83%

Necrotizing Fasciitis: A Study of 48 Cases

2013

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Necrotizing fasciitis represents a group of highly lethal infections characterized by rapidly progressing inflammation and necrosis. The aim of the study was to analyze the clinical profile, microbial flora, and predisposing risk factors in patients with necrotizing fasciitis. Lastly, we aimed to formulate a protocol for management of necrotizing fasciitis. Forty-eight cases of necrotizing fasciitis patients who reported to our hospital between April 2007 and September 2009 were included in the study. The commonest predisposing factors were age greater than 50 years (58 % cases) and diabetes mellitus (52 % cases). The commonest site involved was extremity (70.8 %). Majority of infections were polymicrobial (87.5 %). Repeated aggressive debridement was the commonest surgical procedure performed. Early and aggressive surgical debridement, often in multiple sittings, supplemented by appropriate antibiotics and supportive therapy, forms the key to a successful outcome in necrotizing fasciitis.

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Section: Discussionmentioning

confidence: 83%

Necrotizing Fasciitis: A Study of 48 Cases

2013

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“…Mortality from this disease is up to 40%, with around 500 cases per year. 1,2 Necrotising fasciitis infection is categorised as type 1 (infection from both aerobic and anaerobic bacteria) and type 2 (group A betahaemolytic Streptococcus and Staphylococcus aureus). 3 The high morbidity and mortality associated with necrotising fasciitis has not changed markedly since its description over 50 years ago.…”

Section: Introductionmentioning

confidence: 99%

“…6 Imaging modalities such as computed tomography, magnetic resonance imaging and frozen section biopsy have been previously used in the discrimination between necrotising fasciitis and other soft tissue infections but these methods have been limited by cost and availability. 2,7,8 The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) is a clinical tool first described by Wong C et al 9 The tool is based on six common serum parameters at the time of presentation: C-reactive protein (CRP), total white cell count, haemoglobin, serum sodium, creatinine and glucose (Table 1). An LRINEC of six or greater confers a higher risk of necrotising fasciitis.…”

Section: Introductionmentioning

confidence: 99%

Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature

Bechar

Sepehripour

Hardwicke

et al. 2017

annals

155

106

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INTRODUCTION Early operative debridement of necrotising fasciitis is a major outcome determinant. Identification and diagnosis of such patients can be clinically difficult. The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score first published in 2004 is based on routinely performed parameters and offers a method for identifying early cases. No literature review has yet been performed on the application of such a score. METHODS A systematic review of English-language literature was performed from 2004 to 2014 to identify articles reporting use of LRINEC score and the incidence of necrotising fasciitis. We performed a critical review of PubMed, Medline and Embase in line with the PRISMA statement. A meta-analysis was performed with a random effects model and 95% confidence interval. Suitable correlation coefficient and receiver operating characteristic (ROC) curves were also calculated. RESULTS After application of inclusion criteria, 16 studies with 846 patients were included. The mean LRINEC score in patients with necrotising fasciitis was 6.06. Two papers reported LRINEC score in patients without necrotising fasciitis with a mean 2.45. All six studies with a reported coefficient of variance were < 1; Pearson correlation coefficient was r = 0.637 (P = 0.011). An ROC curve showed an area under the curve of 0.927. CONCLUSIONS The LRINEC score is a useful clinical determinant in the diagnosis and surgical treatment of patients with necrotising fasciitis, with a statistically positive correlation between LRINEC score and a true diagnosis of necrotising fasciitis.

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“…Majority of NF patients present with severe pain out of proportion to the swelling or erythema [6,8,12,16]. Few other features of diagnostic importance are tenderness extending beyond the area of swelling & erythema, due to enzymes and toxins spreading along the fascia below the skin, indistinct margins, absence of superficial lymphangitis and rapid worsening despite antibiotics usage [33]. Repeated review of the patient"s condition for spread of signs and worsening symptoms will prompt the clinician to venture further.…”

Section: Discussionmentioning

confidence: 99%