EBQ:LRINEC Score - Revision history

Ostermayer: Text replacement - "Category:Derm" to "Category:Dermatology"

2016-03-22T13:22:16Z

Text replacement - "Category:Derm" to "Category:Dermatology"

← Older revision		Revision as of 13:22, 22 March 2016
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	[[Category:EBQ]]		[[Category:EBQ]]
	[[Category:Trauma]]		[[Category:Trauma]]
	[[Category:~~Derm~~]]		[[Category:Dermatology]]
	[[Category:Critical Care]]		[[Category:Critical Care]]

Ostermayer: /* Major Points */

2015-11-28T21:17:22Z

Major Points

← Older revision		Revision as of 21:17, 28 November 2015
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	Using six laboratory measurements a Score greater than or equal to 6 indicates that necrotizing fasciitis (NF) should be considered high on the differential diagnosis. The LRINEC Scoring system is:		Using six laboratory measurements a Score greater than or equal to 6 indicates that necrotizing fasciitis (NF) should be considered high on the differential diagnosis. The LRINEC Scoring system is:

			==LRINEC Scoring==
	{{LRINEC SCORE}}		{{LRINEC SCORE}}

Arsmd at 01:11, 11 April 2015

2015-04-11T01:11:32Z

← Older revision		Revision as of 01:11, 11 April 2015
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	==Clinical Question==		==Clinical Question==
	*Is it possible to develop a diagnostic scoring system to distinguish necrotizing fasciitis (NF) from other soft tissue infections based on laboratory tests routinely performed for the evaluation of severe soft tissue infections?		*Is it possible to develop a diagnostic scoring system to distinguish necrotizing fasciitis (NF) from other soft tissue infections based on laboratory tests routinely performed for the evaluation of severe soft tissue infections?
	* Developed the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score to aid in the to risk stratification of patients presenting with signs of cellulitis in order determine likelihoood of NF.		*Developed the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score to aid in the to risk stratification of patients presenting with signs of cellulitis in order determine likelihoood of NF.

	==Conclusion==		==Conclusion==
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	==Study Design==		==Study Design==
	* Retrospective observational study, two teaching tertiary care hospitals		* Retrospective observational study, two teaching tertiary care hospitals from 1997-2002
	* Patients divided into a developmental cohort (N=314) and a validation cohort (N=140)		* Patients divided into a developmental cohort (N=314) and a validation cohort (N=140)

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	===Patient Demographics===		===Patient Demographics===
	*Patients		*Patients
	**145 with ~~Nec Fas~~		**145 with NF (study patients)
	**309 with severe cellulitis or abscesses		**309 with severe cellulitis or abscesses (controls)
	*Mean Age: 51.5 yo		*Mean Age: 51.5 yo
	*Male Gender: 63%		*Male Gender: 63%
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	===Inclusion Criteria===		===Inclusion Criteria===
	Patients were identified through a computer-generated search through the Medical Records Department for all patients diagnosed with ~~necrotizing~~. Control patients were randomly selected from ~~Two thousand five hundred fifty-five~~ patients admitted with the diagnosis of cellulitis or abscesses during the same period. Control patients were randomly selected from this patient pool.		*Patients were identified through a computer-generated search through the Medical Records Department for all patients diagnosed with NF.
			*Control patients were randomly selected (SAS statistical software) from 2555 patients admitted with the diagnosis of cellulitis or abscesses during the same period. Control patients were randomly selected from this patient pool.
			**Severe soft tissue infections: based on documentation in the patients’ charts, the use of parenteral antibiotics for >48 hrs, and abscesses (when present) needing surgical debridement.

	Internal validation of the data set was done by bootstrap resampling technique.		Internal validation of the data set was done by bootstrap resampling technique.
			External validation: performed in a separate cohort of 56 consecutive patients with necrotizing fasciitis seen at a separate hospital (Singapore General Hospital) be- tween June 1999 and December 2002.
			*Eighty-four patients were randomly selected from patients admitted to that hospital for severe cellulitis or abscesses during the same period and used as controls.

	===Exclusion Criteria===		===Exclusion Criteria===
	*Controls were excluded from the retrospective controls Patients with a length of stay of >48 hrs and the use of oral antibiotics only were excluded as these patients were considered		*Controls were excluded from the retrospective controls. Patients with a length of stay of <48 hrs and the use of oral antibiotics only were excluded as these patients were considered
	to have minor soft tissue infections.		to have minor soft tissue infections.

	==Interventions==		==Interventions==
	Since this was a derivation with a internal validation in a retrospective fashion there were no interventions		Since this was a derivation with a internal validation in a retrospective fashion there were no interventions

	==Outcomes==		==Outcomes==
	*In the developmental cohort of 89 patients, only 13 (14.6%) patients had a diagnosis or suspicion of necrotizing fasciitis on admission. A majority were therefore initially missed, resulting in delayed operative debridement. In contrast, 80 (89.9%) of these patients had a LRINEC score of �6.		*In the developmental cohort of 89 patients, only 13 (14.6%) patients had a diagnosis or suspicion of necrotizing fasciitis on admission. A majority were therefore initially missed, resulting in delayed operative debridement. In contrast, 80 (89.9%) of these patients had a LRINEC score of >6.

	*A score of �8 is strongly predictive of necrotizing fasciitis (positive predictive value, 93.4%; 95% CI, 85.5–97.2).		*A score of >8 is strongly predictive of necrotizing fasciitis (positive predictive value, 93.4%; 95% CI, 85.5–97.2).

	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
	*Prior to derivation of the LRINEC score, the admission WBC > 15.4 x 10(9)/L or serum sodium [Na] < 135 mmol/L) was ~~sugested~~ as a method for distinguishing between patients with NF and nonnecrotizing soft tissue infection (non-NF). These two criteria had a PPV 26% and NPV 99%<ref>Wall DB et al. A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection. J Am Coll Surg. 2000 Sep;191(3):227-31.</ref>		*Prior to derivation of the LRINEC score, the admission WBC > 15.4 x 10(9)/L or serum sodium [Na] < 135 mmol/L) was suggested as a method for distinguishing between patients with NF and nonnecrotizing soft tissue infection (non-NF). These two criteria had a PPV 26% and NPV 99%<ref>Wall DB et al. A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection. J Am Coll Surg. 2000 Sep;191(3):227-31.</ref>

	*Other cases have shown than necrotizing fasciitis can exist in LRINEC cases of score 0 giving further support to clinical judgment overriding any scoring system for NF		*'''Other cases have shown than necrotizing fasciitis can exist in LRINEC cases of score 0 giving further support to clinical judgment overriding any scoring system for NF.'''
	*This score was retrospectively derived and retrospectively validated and caution should be applied when relying on this rule since there has not been a prospective derivation. Clinical judgement should be used as the ultimate guide for escalating care for operative managment.		*This score was retrospectively derived and retrospectively validated and caution should be applied when relying on this rule since there has not been a prospective derivation. Clinical judgement should be used as the ultimate guide for escalating care for operative managment.

	==Funding==		==Funding==
	~~none~~		None

	==See Also==		==See Also==

Arsmd: /* Patient Demographics */

2015-04-11T00:58:56Z

Patient Demographics

← Older revision		Revision as of 00:58, 11 April 2015
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	==Population==		==Population==
	===Patient Demographics===		===Patient Demographics===
			*Patients
			**145 with Nec Fas
			**309 with severe cellulitis or abscesses
	*Mean Age: 51.5 yo		*Mean Age: 51.5 yo
	*Male Gender: 63%		*Male Gender: 63%
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	**Diabetes: 61%		**Diabetes: 61%
	**PVD: 19%		**PVD: 19%

	===Inclusion Criteria===		===Inclusion Criteria===
	Patients were identified through a computer-generated search through the Medical Records Department for all patients diagnosed with necrotizing. Control patients were randomly selected from Two thousand five hundred fifty-five patients admitted with the diagnosis of cellulitis or abscesses during the same period. Control patients were randomly selected from this patient pool.		Patients were identified through a computer-generated search through the Medical Records Department for all patients diagnosed with necrotizing. Control patients were randomly selected from Two thousand five hundred fifty-five patients admitted with the diagnosis of cellulitis or abscesses during the same period. Control patients were randomly selected from this patient pool.

Ostermayer at 16:25, 29 December 2014

2014-12-29T16:25:24Z

← Older revision		Revision as of 16:25, 29 December 2014
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	\| fulltexturl= http://ovidsp.tx.ovid.com.journals.labiomed.org/sp-3.12.0b/ovidweb.cgi?T=JS&PAGE=fulltext&D=ovft&AN=00003246-200407000-00011&NEWS=N&CSC=Y&CHANNEL=PubMed		\| fulltexturl= http://ovidsp.tx.ovid.com.journals.labiomed.org/sp-3.12.0b/ovidweb.cgi?T=JS&PAGE=fulltext&D=ovft&AN=00003246-200407000-00011&NEWS=N&CSC=Y&CHANNEL=PubMed
	\| pdfurl=http://theddx.org/papers/LRINEC.pdf		\| pdfurl=http://theddx.org/papers/LRINEC.pdf
	\| status=~~Under Review~~		\| status=Complete
	}}		}}
	==Clinical Question==		==Clinical Question==

Ostermayer at 16:24, 29 December 2014

2014-12-29T16:24:47Z

← Older revision		Revision as of 16:24, 29 December 2014
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	**PVD: 19%		**PVD: 19%
	===Inclusion Criteria===		===Inclusion Criteria===
	Patients were identified through a computer-generated search through the Medical Records Department for all patients diagnosed with necrotizing. Control patients were randomly selected from Two thousand five hundred fifty-five patients admitted with the diagnosis of cellulitis or abscesses during the same period. Control patients were randomly selected from this patient pool.		Patients were identified through a computer-generated search through the Medical Records Department for all patients diagnosed with necrotizing. Control patients were randomly selected from Two thousand five hundred fifty-five patients admitted with the diagnosis of cellulitis or abscesses during the same period. Control patients were randomly selected from this patient pool.

	Internal validation of the data set was done by bootstrap resampling technique.		Internal validation of the data set was done by bootstrap resampling technique.
	===Exclusion Criteria===		===Exclusion Criteria===
	*Controls were excluded from the retrospective controls Patients with a length of stay of ~~�48~~ hrs and the use of oral antibiotics only were excluded as these patients were considered		*Controls were excluded from the retrospective controls Patients with a length of stay of >48 hrs and the use of oral antibiotics only were excluded as these patients were considered
	to have minor soft tissue infections.		to have minor soft tissue infections.
	==Interventions==		==Interventions==
	Since this was a derivation with a internal validation in a retrospective fashion there were no interventions		Since this was a derivation with a internal validation in a retrospective fashion there were no interventions
	==Outcomes==		==Outcomes==
	*In the developmental cohort of 89 patients, only 13 (14.6%) patients had a diagnosis or suspicion of necrotizing fasciitis on admission		*In the developmental cohort of 89 patients, only 13 (14.6%) patients had a diagnosis or suspicion of necrotizing fasciitis on admission. A majority were therefore initially missed, resulting in delayed operative debridement. In contrast, 80 (89.9%) of these patients had a LRINEC score of �6.

	~~===Primary Outcome===~~		*A score of �8 is strongly predictive of necrotizing fasciitis (positive predictive value, 93.4%; 95% CI, 85.5–97.2).


	~~===Secondary Outcomes===~~



	~~===Subgroup analysis===~~



	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
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	*Other cases have shown than necrotizing fasciitis can exist in LRINEC cases of score 0 giving further support to clinical judgment overriding any scoring system for NF		*Other cases have shown than necrotizing fasciitis can exist in LRINEC cases of score 0 giving further support to clinical judgment overriding any scoring system for NF
			*This score was retrospectively derived and retrospectively validated and caution should be applied when relying on this rule since there has not been a prospective derivation. Clinical judgement should be used as the ultimate guide for escalating care for operative managment.

	==Funding==		==Funding==
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	==See Also==		==See Also==
	*[[Necrotizing Fasciitis]]		*[[Necrotizing Fasciitis]]
			*[[Fournier Gangrene]]

	==External Links==		==External Links==

Ostermayer at 16:08, 29 December 2014

2014-12-29T16:08:57Z

← Older revision		Revision as of 16:08, 29 December 2014
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	==Major Points==		==Major Points==
	Using six laboratory measurements a Score greater than or equal to 6 indicates that necrotizing fasciitis should be considered high on the differential diagnosis. The LRINEC Scoring system is:		Using six laboratory measurements a Score greater than or equal to 6 indicates that necrotizing fasciitis (NF) should be considered high on the differential diagnosis. The LRINEC Scoring system is:

	{{LRINEC SCORE}}		{{LRINEC SCORE}}
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	==Population==		==Population==
	===Patient Demographics===		===Patient Demographics===
			*Mean Age: 51.5 yo
			*Male Gender: 63%
			*Comorbidities
			**Diabetes: 61%
			**PVD: 19%
	===Inclusion Criteria===		===Inclusion Criteria===
			Patients were identified through a computer-generated search through the Medical Records Department for all patients diagnosed with necrotizing. Control patients were randomly selected from Two thousand five hundred fifty-five patients admitted with the diagnosis of cellulitis or abscesses during the same period. Control patients were randomly selected from this patient pool.

			Internal validation of the data set was done by bootstrap resampling technique.
	===Exclusion Criteria===		===Exclusion Criteria===
			*Controls were excluded from the retrospective controls Patients with a length of stay of �48 hrs and the use of oral antibiotics only were excluded as these patients were considered
			to have minor soft tissue infections.
	==Interventions==		==Interventions==
			Since this was a derivation with a internal validation in a retrospective fashion there were no interventions
	==Outcomes==		==Outcomes==
			*In the developmental cohort of 89 patients, only 13 (14.6%) patients had a diagnosis or suspicion of necrotizing fasciitis on admission

	===Primary Outcome===		===Primary Outcome===
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	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
	Prior to derivation of the LRINEC score, the admission WBC > 15.4 x 10(9)/L or serum sodium [Na] < 135 mmol/L) was sugested as a method for distinguishing between patients with NF and nonnecrotizing soft tissue infection (non-NF). These two criteria had a PPV 26% and NPV 99%<ref>Wall DB et al. A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection. J Am Coll Surg. 2000 Sep;191(3):227-31.</ref>		*Prior to derivation of the LRINEC score, the admission WBC > 15.4 x 10(9)/L or serum sodium [Na] < 135 mmol/L) was sugested as a method for distinguishing between patients with NF and nonnecrotizing soft tissue infection (non-NF). These two criteria had a PPV 26% and NPV 99%<ref>Wall DB et al. A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection. J Am Coll Surg. 2000 Sep;191(3):227-31.</ref>

			*Other cases have shown than necrotizing fasciitis can exist in LRINEC cases of score 0 giving further support to clinical judgment overriding any scoring system for NF

	==Funding==		==Funding==
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	==See Also==		==See Also==
	[[~~Necrotizing_Fasciitis~~]]		*[[Necrotizing Fasciitis]]

			==External Links==
			*[http://www.mdcalc.com/lrinec-score-for-necrotizing-soft-tissue-infection/ MDCalc - LRINEC]

	==Sources==		==Sources==

Ostermayer: /* Criticisms & Further Discussion */

2014-12-29T15:39:31Z

Criticisms & Further Discussion

← Older revision		Revision as of 15:39, 29 December 2014
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	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
			Prior to derivation of the LRINEC score, the admission WBC > 15.4 x 10(9)/L or serum sodium [Na] < 135 mmol/L) was sugested as a method for distinguishing between patients with NF and nonnecrotizing soft tissue infection (non-NF). These two criteria had a PPV 26% and NPV 99%<ref>Wall DB et al. A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection. J Am Coll Surg. 2000 Sep;191(3):227-31.</ref>


	==Funding==		==Funding==

Ostermayer at 15:29, 29 December 2014

2014-12-29T15:29:56Z

← Older revision		Revision as of 15:29, 29 December 2014
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	==Major Points==		==Major Points==
	Using six laboratory measurements a Score greater than or equal to 6 indicates that necrotizing fasciitis should be considered high on the differential diagnosis. The LRINEC Scoring system is:		Using six laboratory measurements a Score greater than or equal to 6 indicates that necrotizing fasciitis should be considered high on the differential diagnosis. The LRINEC Scoring system is:
	*CRP (mg/L) ≥150: '''4 points'''
	*WBC count (×10<sup>3</sup>/mm<sup>3</sup>)		{{LRINEC SCORE}}
	**<15: '''0 points'''
	**15–25: '''1 point'''
	**>25: '''2 points'''
	*Hemoglobin (g/dL)
	**>13.5: '''0 points'''
	**11–13.5: '''1 point'''
	**<11: '''2 points'''
	*Sodium (mmol/L) <135: '''2 points'''
	*Creatinine (umol/L) >141: '''2 points'''
	*Glucose (mmol/L) >10: '''1 point'''


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	==Funding==		==Funding==
	none		none

			==See Also==
			[[Necrotizing_Fasciitis]]

	==Sources==		==Sources==

Ostermayer: /* Sources */

2014-12-29T15:25:18Z

Sources

← Older revision		Revision as of 15:25, 29 December 2014
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	[[Category:EBQ]]		[[Category:EBQ]]
	[[Category:Trauma]]		[[Category:Trauma]]
	[{Category:Derm]]		[[Category:Derm]]
	[[Category:Critical Care]]		[[Category:Critical Care]]