Abstract
IntroductionNecrotising fasciitis is a life-threatening illness that is often difficult to diagnose. Immediate debridement and intravenous antibiotic therapy are required to limit the spread of infection. This five-year audit aimed to review the number and outcomes of all cases of necrotising fasciitis admitted to a tertiary referral unit and to assess the validity of the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scoring system.MethodsA retrospective analysis of patient notes over the five-year period from October 2006 to October 2011 was undertaken. The LRINEC score was calculated for each patient to evaluate its usefulness.ResultsOverall, 15 patients were diagnosed with necrotising fasciitis. Three patients died. The median age of patients was 51.0 years (range: 34–76 years). There were no obvious predisposing factors in 8 cases but patients had a median of 2.0 co-morbidities. The most common infective agent, present in five patients, was Group A Streptococcus. Other monomicrobial agents included Group G Streptococcus and Klebsiella pneumoniae. Polymicrobial infections were less common than monomicrobial infections and two patients had a polymicrobial infection including methicillin-resistant Staphylococcus aureus. Although the LRINEC scoring system identified 12 of the 15 patients as having a high or intermediate likelihood of necrotising fasciitis, 3 were classified as low likelihood.ConclusionsThis limited case series strongly suggests that the LRINEC system is too insensitive for diagnosis.
Highlights
Necrotising fasciitis is a life-threatening illness that is often difficult to diagnose
The validity of the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scoring system was evaluated. This was a retrospective review of the medical records of patients who developed necrotising fasciitis during the period between October 2006 and October 2011 at a tertiary referral unit in London
A diagnosis of necrotising fasciitis was made based on clinical findings and confirmed on surgical investigation revealing grey necrotic tissue, lack of dermal bleeding, lack of resistance on blunt dissection and foul ‘dishwater’ pus
Summary
Necrotising fasciitis is a life-threatening illness that is often difficult to diagnose. Immediate debridement and intravenous antibiotic therapy are required to limit the spread of infection. This five-year audit aimed to review the number and outcomes of all cases of necrotising fasciitis admitted to a tertiary referral unit and to assess the validity of the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scoring system. RESULTS Overall, 15 patients were diagnosed with necrotising fasciitis. The most common infective agent, present in five patients, was Group A Streptococcus. Polymicrobial infections were less common than monomicrobial infections and two patients had a polymicrobial infection including methicillin-resistant Staphylococcus aureus. The LRINEC scoring system identified 12 of the 15 patients as having a high or intermediate likelihood of necrotising fasciitis, 3 were classified as low likelihood. CONCLUSIONS This limited case series strongly suggests that the LRINEC system is too insensitive for diagnosis
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More From: The Annals of The Royal College of Surgeons of England
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