Vishvak Chanthar, K M M (2014) LRINEC: An Objective Scoring System as a tool for early diagnosis of Necrotizing Fasciitis. Masters thesis, Coimbatore Medical College, Coimbatore.
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Abstract
BACKGROUND: Skin and/or subcutaneous tissue infections are highly diverse with regard to etiology, predisposing organisms, incidence, clinical features, severity and complications. The spectrum of deep soft tissue infections ranges from localized lesions to rapidly spreading, tissue destructive infections such as necrotizing fasciitis and myonecrosis. Necrotizing soft tissue infections are often fatal, characterized by extensive necrosis of the subcutaneous tissues and fascia. The reported mortality of 30-40% reflects the inadequacy of early recognition of Necrotizing soft tissue infections. This study emphasizes on the search for a tool that reliably and rapidly identifies patients with NF and helps to decide for earlier effective therapy to modify clinical outcome. AIM OF THE STUDY: To Validate the LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score as a tool for early distinguishing of Necrotizing Fasciitis from other infections of the soft tissues. METHODS: Sixty of patients with soft tissue infections were evaluated prospectively on the basis of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC). Based on their LRINEC score, the patients were categorised as Low, Intermediate and High Risk for the onset of Necrotizing fasciitis. Patients in each category were appropriately managed. All variables in terms of progression of the disease, associated co-morbidity, onset of necrotizing fasciitis, number of debridement, outcome of the disease in each category were documented and statistically analysed to evaluate the significance of LRINEC score in predicting the onset of Necrotizing fasciitis and its clinical outcomes. RESULTS: A total of 60 patients with soft tissue infections were prospectively evaluated in this study and categorised on the basis of LRINEC score – 45 patients in Low risk category, 7 in Intermediate risk and 8 patients in High risk group. This study included forty two males (70%) and eighteen females (30%). Diabetes mellitus was the most common co-morbidity (23 cases). Tissue diagnosis was positive for necrotizing fasciitis in 7 cases of low risk, 1 case in intermediate risk and 3 cases in high risk group. Required mean number of debridement is 1.6 times. In terms of outcome, all cases (including positive tissue diagnosis cases) in low risk and intermediate risk groups and 2 cases in high risk group were improved with surgical dedridement/fasciotomy. 2 cases required amputation and 3 cases were dead. There is no statistically significant difference between the mean age between the groups of severity. The cut off of LRINEC ≥ 6 has better sensitivity and specificity in identifying the risk of the patient. The p-value (0.001) reveals that there is an association between Diabetes Mellitus and the severity of risk. The pvalue (0.08) for the comparison of mean hospital days among the group of severity indicates that there is no difference between the mean of hospital stay. CONCLUSION: LRINEC scoring system has a better positive predictive value in identifying the onset of necrotizing fasciitis and risk strategizing of the patients with severe soft tissue infections. There is a statistically significant association between Diabetic Mellitus and the severity of risk. The significance of LRINEC score in predicting the clinical outcome of the disease could not be outlined because of limited population included in this study. Further studies are needed to determine whether additional interventions targeted to the high mortality risk group can lead to improved outcomes.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Necrotizing Fasciitis ; Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC). |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 06 Jul 2018 16:36 |
| Last Modified: | 06 Jul 2018 16:36 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8682 |
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