Nithin Kumar, M (2020) Validation of LRINEC (Laboratory Risk Indicator for Necrotising Fascitis) Scoring System for the Diagnosis of Necrotising Fascitis in Patients Presenting with Tissue Infections. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
INTRODUCTION: Necrotizing fascitis is perhaps the most severe form of soft tissue infection primarily involving the superficial fascia. Mortality of this disease remains alarmingly high with reported mortality rates ranging from 6 to 76%. Delayed diagnosis and consequently delayed operative debridement have been shown in multiple studies to increase mortality. The paucity of specific cutaneous signs to distinguish necrotising fascitis from other soft tissue infections such as cellulitis makes the diagnosis extremely difficult. So a scoring system which is easy to follow and cost effective with high positive and negative predictive value is required. One such scoring system is the LRINEC scoring system devised by Wong.Et.al.in 2005 which claims to have a positive predictive value of 92.0% and negative predictive value of 96.0%. Hence we validated this scoring system in our patients and found to have similar comparable predictive values, it would be a boon to developing countries like India where the mortality of the disease reported ranges from 7 to 76% and also where there is also constraint for resources. AIM & OBJECTIVES: 1. To validate the LRINEC scoring system for the diagnosis of necrotizing fascitis among patients presenting with soft tissue infections to TVMCH, Tirunelveli. 2. To determine the positive predictive value and negative predictive value of LRINEC scoring system for diagnosing necrotising fascitis. MATERIALS AND METHODS: STUDY SUBJECTS: All patients who presented to Dept. of general surgery – TVMCH with symptoms suggestive of soft tissue infections. STUDY DURATION - January 2018 to September 2018. METHODS OF COLLECTION OF DATA: Patients who presented with symptoms suggestive of soft tissue infections underwent clinical examinations and mentioned investigations. Following which information regarding the demographics & covariates of soft tissue infections have been collected using a pretested semi-structured proforma cum observational checklist. LRINEC scoring system was applied to each of the study subjects. The confirmatory diagnosis for necrotising fascitis was done with histopathology for all patients, irrespective of the result of the LRINEC scoring system. RESULTS: Diabetes mellitus is being responsible for most cases of soft tissue infection in my study group around 46%. In LRINEC score variables, Hemoglobin < 13gm% is being the most common biochemical abnormality that is seen in necrotising fascitis around 77 patients. Out of 100 patients, 80 patients had LRINEC score < 5 and 20 patients had LRINEC score > or =6. HPE group shows, out of 100 patients, 78 had cellulitis, 22 had necrotising fascitis. While comparing the HPE with the LRINEC scoring system, 18 patients were true positive for NF, 76 patients true negative for NF, 2 patients were false positive and 4 patients were false negative. In my study, the sensitivity is 81.82%, specificity is 97.44%, positive predictive value is 90.00%, negative predictive value is 95.00% and accuracy is 94.00%. CONCLUSION: The LRINEC score is a robust score capable of detecting even clinically early cases of necrotising fasciitis. The variables used are routinely measured to assess severe soft tissue infection. Patients with a LRINEC score of ≥6 should be carefully evaluated for the presence of necrotising fasciitis.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221711360 |
| Uncontrolled Keywords: | Laboratory Risk Indicator for Necrotising Fascitis (LRINEC), Necrotising fascitis, Diabetes mellitus, HPE, Hemoglobin. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 11 Feb 2021 02:00 |
| Last Modified: | 11 Feb 2021 02:00 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14038 |
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