A Case of Necrotizing Fasciitis with a LRINEC Score of Zero: Clinical Suspicion Should Trump Scoring Systems
Abstract Background Necrotizing fasciitis (NF) is a potentially lethal infection involving the skin, subcutaneous tissue, and fascia. The Laboratory Risk Indicator for Necrotizing fasciitis (LRINEC) score has been proposed as a way of using abnormal laboratory values to distinguish between severe ce...
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| Veröffentlicht in: | The Journal of emergency medicine 2013-05, Vol.44 (5), p.928-931 |
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| container_title | The Journal of emergency medicine |
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| creator | Wilson, Michael P., PhD, MD Schneir, Aaron B., MD |
| description | Abstract Background Necrotizing fasciitis (NF) is a potentially lethal infection involving the skin, subcutaneous tissue, and fascia. The Laboratory Risk Indicator for Necrotizing fasciitis (LRINEC) score has been proposed as a way of using abnormal laboratory values to distinguish between severe cellulitis and necrotizing fasciitis. Objectives The utility of the LRINEC system, including a review of current literature on this scoring system, is discussed. Case Report A case of a 37-year-old man is presented. As part of the diagnostic work-up, appropriate laboratory tests necessary to calculate a LRINEC score were obtained. Despite a LRINEC score of 0, NF was later confirmed at surgery. Conclusions Although the LRINEC score has been proposed as a robust way of identifying patients with early NF, it failed to detect NF in the patient reported here. NF should thus remain primarily a disease of clinical suspicion, and this suspicion should trump the LRINEC score. |
| doi_str_mv | 10.1016/j.jemermed.2012.09.039 |
| format | Article |
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The Laboratory Risk Indicator for Necrotizing fasciitis (LRINEC) score has been proposed as a way of using abnormal laboratory values to distinguish between severe cellulitis and necrotizing fasciitis. Objectives The utility of the LRINEC system, including a review of current literature on this scoring system, is discussed. Case Report A case of a 37-year-old man is presented. As part of the diagnostic work-up, appropriate laboratory tests necessary to calculate a LRINEC score were obtained. Despite a LRINEC score of 0, NF was later confirmed at surgery. Conclusions Although the LRINEC score has been proposed as a robust way of identifying patients with early NF, it failed to detect NF in the patient reported here. NF should thus remain primarily a disease of clinical suspicion, and this suspicion should trump the LRINEC score.</description><identifier>ISSN: 0736-4679</identifier><identifier>EISSN: 2352-5029</identifier><identifier>DOI: 10.1016/j.jemermed.2012.09.039</identifier><identifier>PMID: 23287745</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Blood Glucose - analysis ; C-Reactive Protein - analysis ; Creatinine - analysis ; Emergency ; Emergency Service, Hospital ; Fasciitis, Necrotizing - diagnosis ; Fasciitis, Necrotizing - microbiology ; Fasciitis, Necrotizing - therapy ; Hemoglobins - analysis ; Humans ; Lactic Acid - blood ; Leukocyte Count ; LRINEC score ; Male ; nec fasc ; necrotizing fasciitis ; Risk Assessment - methods ; Sodium - analysis ; Tomography, X-Ray Computed</subject><ispartof>The Journal of emergency medicine, 2013-05, Vol.44 (5), p.928-931</ispartof><rights>Elsevier Inc.</rights><rights>2013 Elsevier Inc.</rights><rights>Copyright © 2013 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c423t-f4160d25273f33733ac67c1d298064b9be6aa433b3e995066ce9c4ba4cdda7f73</citedby><cites>FETCH-LOGICAL-c423t-f4160d25273f33733ac67c1d298064b9be6aa433b3e995066ce9c4ba4cdda7f73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jemermed.2012.09.039$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27928,27929,45999</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23287745$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wilson, Michael P., PhD, MD</creatorcontrib><creatorcontrib>Schneir, Aaron B., MD</creatorcontrib><title>A Case of Necrotizing Fasciitis with a LRINEC Score of Zero: Clinical Suspicion Should Trump Scoring Systems</title><title>The Journal of emergency medicine</title><addtitle>J Emerg Med</addtitle><description>Abstract Background Necrotizing fasciitis (NF) is a potentially lethal infection involving the skin, subcutaneous tissue, and fascia. The Laboratory Risk Indicator for Necrotizing fasciitis (LRINEC) score has been proposed as a way of using abnormal laboratory values to distinguish between severe cellulitis and necrotizing fasciitis. Objectives The utility of the LRINEC system, including a review of current literature on this scoring system, is discussed. Case Report A case of a 37-year-old man is presented. As part of the diagnostic work-up, appropriate laboratory tests necessary to calculate a LRINEC score were obtained. Despite a LRINEC score of 0, NF was later confirmed at surgery. Conclusions Although the LRINEC score has been proposed as a robust way of identifying patients with early NF, it failed to detect NF in the patient reported here. NF should thus remain primarily a disease of clinical suspicion, and this suspicion should trump the LRINEC score.</description><subject>Adult</subject><subject>Blood Glucose - analysis</subject><subject>C-Reactive Protein - analysis</subject><subject>Creatinine - analysis</subject><subject>Emergency</subject><subject>Emergency Service, Hospital</subject><subject>Fasciitis, Necrotizing - diagnosis</subject><subject>Fasciitis, Necrotizing - microbiology</subject><subject>Fasciitis, Necrotizing - therapy</subject><subject>Hemoglobins - analysis</subject><subject>Humans</subject><subject>Lactic Acid - blood</subject><subject>Leukocyte Count</subject><subject>LRINEC score</subject><subject>Male</subject><subject>nec fasc</subject><subject>necrotizing fasciitis</subject><subject>Risk Assessment - methods</subject><subject>Sodium - analysis</subject><subject>Tomography, X-Ray Computed</subject><issn>0736-4679</issn><issn>2352-5029</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1u1DAURi0EokPhFSov2ST4L_aYBaKKWlppVCRSNmwsx7mhHpJ4sJOi4embdGY2bFh54fN9V_dchC4oySmh8sM230IPsYcmZ4SynOiccP0CrRgvWFYQpl-iFVFcZkIqfYbepLQlhCqypq_RGeNsrZQoVqi7xKVNgEOL78DFMPq_fviJr21y3o8-4T9-fMAWb77d3l2VuHIhPsM_IIaPuOz84J3tcDWlnXc-DLh6CFPX4Ps49btnfKmr9mmEPr1Fr1rbJXh3fM_R9-ur-_Im23z9cltebjInGB-zVlBJGlYwxVvOFefWSeVow_SaSFHrGqS1gvOag9YFkdKBdqK2wjWNVa3i5-j9oXcXw-8J0mh6nxx0nR0gTMlQLjTRBeNiRuUBnXdPKUJrdtH3Nu4NJWYxbbbmZNospg3RZjY9By-OM6Z6-TvFTmpn4PMBgHnTRw_RzEphcND4CG40TfD_n_Hpnwp3FP4L9pC2YYrD7NFQk-aMqZZ7L-emSwmlBX8CI4Cm8w</recordid><startdate>20130501</startdate><enddate>20130501</enddate><creator>Wilson, Michael P., PhD, MD</creator><creator>Schneir, Aaron B., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130501</creationdate><title>A Case of Necrotizing Fasciitis with a LRINEC Score of Zero: Clinical Suspicion Should Trump Scoring Systems</title><author>Wilson, Michael P., PhD, MD ; Schneir, Aaron B., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c423t-f4160d25273f33733ac67c1d298064b9be6aa433b3e995066ce9c4ba4cdda7f73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Blood Glucose - analysis</topic><topic>C-Reactive Protein - analysis</topic><topic>Creatinine - analysis</topic><topic>Emergency</topic><topic>Emergency Service, Hospital</topic><topic>Fasciitis, Necrotizing - diagnosis</topic><topic>Fasciitis, Necrotizing - microbiology</topic><topic>Fasciitis, Necrotizing - therapy</topic><topic>Hemoglobins - analysis</topic><topic>Humans</topic><topic>Lactic Acid - blood</topic><topic>Leukocyte Count</topic><topic>LRINEC score</topic><topic>Male</topic><topic>nec fasc</topic><topic>necrotizing fasciitis</topic><topic>Risk Assessment - methods</topic><topic>Sodium - analysis</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wilson, Michael P., PhD, MD</creatorcontrib><creatorcontrib>Schneir, Aaron B., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wilson, Michael P., PhD, MD</au><au>Schneir, Aaron B., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Case of Necrotizing Fasciitis with a LRINEC Score of Zero: Clinical Suspicion Should Trump Scoring Systems</atitle><jtitle>The Journal of emergency medicine</jtitle><addtitle>J Emerg Med</addtitle><date>2013-05-01</date><risdate>2013</risdate><volume>44</volume><issue>5</issue><spage>928</spage><epage>931</epage><pages>928-931</pages><issn>0736-4679</issn><eissn>2352-5029</eissn><abstract>Abstract Background Necrotizing fasciitis (NF) is a potentially lethal infection involving the skin, subcutaneous tissue, and fascia. The Laboratory Risk Indicator for Necrotizing fasciitis (LRINEC) score has been proposed as a way of using abnormal laboratory values to distinguish between severe cellulitis and necrotizing fasciitis. Objectives The utility of the LRINEC system, including a review of current literature on this scoring system, is discussed. Case Report A case of a 37-year-old man is presented. As part of the diagnostic work-up, appropriate laboratory tests necessary to calculate a LRINEC score were obtained. Despite a LRINEC score of 0, NF was later confirmed at surgery. Conclusions Although the LRINEC score has been proposed as a robust way of identifying patients with early NF, it failed to detect NF in the patient reported here. NF should thus remain primarily a disease of clinical suspicion, and this suspicion should trump the LRINEC score.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23287745</pmid><doi>10.1016/j.jemermed.2012.09.039</doi><tpages>4</tpages></addata></record> |
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| subjects | Adult Blood Glucose - analysis C-Reactive Protein - analysis Creatinine - analysis Emergency Emergency Service, Hospital Fasciitis, Necrotizing - diagnosis Fasciitis, Necrotizing - microbiology Fasciitis, Necrotizing - therapy Hemoglobins - analysis Humans Lactic Acid - blood Leukocyte Count LRINEC score Male nec fasc necrotizing fasciitis Risk Assessment - methods Sodium - analysis Tomography, X-Ray Computed |
| title | A Case of Necrotizing Fasciitis with a LRINEC Score of Zero: Clinical Suspicion Should Trump Scoring Systems |
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