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. 2021 Nov;278(11):4587-4592.
doi: 10.1007/s00405-021-06653-4. Epub 2021 Feb 9.

Early detecting cervical necrotizing fasciitis from deep neck infections: a study of 550 patients

Giorgos Sideris  1 , Marilia Sapountzi  2 , Vangelis Malamas  3 , Nikolaos Papadimitriou  2 , Pavlos Maragkoudakis  2 , Alexander Delides  2
Affiliations

Early detecting cervical necrotizing fasciitis from deep neck infections: a study of 550 patients

Giorgos Sideris et al. Eur Arch Otorhinolaryngol. 2021 Nov.

Abstract

Purpose: The aim of this retrospective review study is to evaluate Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score as an indicative parameter in early detecting cervical necrotizing fasciitis (CNF) from deep neck infections (DNI).

Methods: We reviewed 12 cases of CNF and 538 cases of non-necrotizing deep neck infection hospitalized in our hospital over the last decade. Cervical necrotizing fasciitis was histologically confirmed.

Results: Using an LRINEC score of 6 as a cutoff sensitivity was calculated at 100% (95% CI 99.9-100) and specificity 72.5% (95% CI 72.4-72.6). Negative predicted value (NPV) was 100% and positive predicted value (PPV) was 7.5%. C-reactive protein (CRP), white blood count (WBC), and glucose (Glu) levels have a higher correlation. Haemoglobin (Hb), sodium (Na), and creatinine (Cr) do not seem to have a big impact in our study.

Conclusion: LRINEC score proves to be a useful "rule-out" tool that works on the safe side with high sensitivity and poor specificity. WBC, CRP, and Glu seem to be the most significant variables of the LRINEC score. Hb, Na, and Cr make the score safer. Decision for surgery must be based on medical history, clinical symptoms and signs, imaging findings, and laboratory tests and not according to the LRINEC score itself.

Keywords: Cervical necrotizing fasciitis; Deep neck abscess; Deep neck space infection; LRINEC; Laboratory risk indicator for necrotizing fasciitis; Necrotizing soft tissue infection.

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References

    1. Cruz Toro P, Callejo Castillo À, Tornero Saltó J, González Compta X, Farré A, Maños M (2014) Cervical necrotizing fasciitis: report of 6 cases and review of literature. Eur Ann Otorhinolaryngol Head Neck Dis 131(6):357–359. https://doi.org/10.1016/j.anorl.2013.08.006 - DOI - PubMed
    1. Stevens DL, Bryant AE (2017) Necrotizing soft-tissue infections. N Engl J Med 377(23):2253–2265. https://doi.org/10.1056/NEJMra1600673 - DOI - PubMed
    1. Shaikh N, Ummunissa F, Hanssen Y, Al Makki H, Shokr HM (2010) Hospital epidemiology of emergent cervical necrotizing fasciitis. J Emerg Trauma Shock 3(2):123–125. https://doi.org/10.4103/0974-2700.62108 - DOI - PubMed - PMC
    1. Gunaratne DA, Tseros EA, Hasan Z et al (2018) Cervical necrotizing fasciitis: systematic review and analysis of 1235 reported cases from the literature. Head Neck 40(9):2094–2102. https://doi.org/10.1002/hed.25184 - DOI - PubMed
    1. Wong CH, Khin LW, Heng KS, Tan KC, Low CO (2004) The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 32(7):1535–1541. https://doi.org/10.1097/01.ccm.0000129486.35458.7d - DOI - PubMed

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