Validation of modified LRINEC scoring system in the early diagnosis of necrotizing fasciitis in patients with soft tissue infections

Abstract

Introduction: Necrotizing fasciitis is a rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. Necrotizing fasciitis moves along the fascial plane. Early recognition and surgical intervention at the earliest possible time are the sole factors in preventing the morbidity and mortality in patients with necrotizing fasciitis. Aims and Objectives: To validate the modified LRINEC scoring system for the early diagnosis of necrotizing fasciitis among patients presenting with soft tissue infections for 1. Early diagnosis of necrotizing fasciitis, 2.To implement modified LRINEC scoring system in patients with all soft tissue infections, 3. Plan of treatment based on Outcome of the modified LRINEC scoring system. Materials and Methods: This was a single centre, prospective observational study conducted from July 2022 to June 2023. It was carried out on 100 patients with soft tissue infections. Results: 43% patients were involved in low risk (<6) M-LRINEC score. 21% patients were under intermediate risk group (6-8) M-LRINEC score and 35% patients were under high risk group (>8) M-LRINEC score.86 Out of 100 patients 57 patients underwent debridement in including intermediate and high risk patients of M-LRINEC score. No debridement was required for patients in low risk M-LRINEC score (<6). Among 57 patients who underwent debridement, 41 patients were confirmed with NF by histopathology which is the gold standard for diagnosing NF. On validation M-LRINEC score has sensitivity of 93.55%. Specificity of 66.67%, positive predictive value of 80.56% and negative predictive value of 89.5% with P value 0.0600. Conclusion: In patients with clinical signs suspicious of severe soft tissue infection, the M-LRINEC score is an effective early diagnostic tool in distinguishing NF from other soft tissue infection in order to secure early management and debridement. M-LRINEC scoring system can be recommended routinely for clinical suspicion and early diagnosis of necrotizing fasciitis.