Wong et al. developed the LRINEC score to identify necrotizing fasciitis from routine admission labs. The study asks: can standard blood work reliably flag NF before clinical findings become obvious? The score was derived in 314 patients and externally validated in 140 additional patients across two tertiary hospitals.
The clinical diagnosis of NF is notoriously unreliable early in the disease — fewer than 1 in 7 patients in this series were correctly identified on admission exam alone. Yet the mortality of NF (21.3%) dwarfs that of severe cellulitis (1.3%), and delay in debridement is a primary driver of death.
Calculate the LRINEC score on every admission for severe soft tissue infection using the labs you are already drawing. Score ≥6 demands urgent further workup: finger test, MRI, or direct OR evaluation. Score ≥8 should be treated as NF until proven otherwise.
Two caveats that will be tested: use admission labs only, because IV fluids, insulin, and transfusions correct the very disturbances the score measures. And never let a reassuring score override strong clinical suspicion. If it looks like NF, the patient goes to the OR regardless of the number.
Wong et al. developed the LRINEC score to identify necrotizing fasciitis from routine admission labs. The study asks: can standard blood work reliably flag NF before clinical findings become obvious? The score was derived in 314 patients and externally validated in 140 additional patients across two tertiary hospitals.
The clinical diagnosis of NF is notoriously unreliable early in the disease — fewer than 1 in 7 patients in this series were correctly identified on admission exam alone. Yet the mortality of NF (21.3%) dwarfs that of severe cellulitis (1.3%), and delay in debridement is a primary driver of death.
Calculate the LRINEC score on every admission for severe soft tissue infection using the labs you are already drawing. Score ≥6 demands urgent further workup: finger test, MRI, or direct OR evaluation. Score ≥8 should be treated as NF until proven otherwise.
Two caveats that will be tested: use admission labs only, because IV fluids, insulin, and transfusions correct the very disturbances the score measures. And never let a reassuring score override strong clinical suspicion. If it looks like NF, the patient goes to the OR regardless of the number.