Fernando SM, Tran A, Cheng W, et al. Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis. Ann Surg. 2019 Jan;269(1):58-65. doi: 10.1097/SLA.0000000000002774. Full-text for Emory users.

Conclusion: “Our systematic review found that individual physical examination signs (fever, hemorrhagic bullae, and hypotension) were poorly sensitive for diagnosis of NSTI. CT had superior sensitivity and specificity to plain radiography in diagnosing NSTI, but may not be readily available in all centers, and may not be suitable for unstable patients. Finally, the LRINEC score was poorly sensitive for diagnosis of NSTI, suggesting that a low score is not sufficient to rule out the diagnosis.”

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See also:

Abu El Hawa AA, Dekker PK, et al. Early Diagnosis and Surgical Management of Necrotizing Fasciitis of the Lower Extremities: Risk Factors for Mortality and Amputation. Adv Wound Care (New Rochelle). 2022 May;11(5):217-225.

Harasawa T, et al. Accurate and quick predictor of necrotizing soft tissue infection: Usefulness of the LRINEC score and NSTI assessment score. J Infect Chemother. 2020 Apr;26(4):331-334.

Nawijn F, Smeeing DPJ, Houwert RM, et al. Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis. World J Emerg Surg. 2020 Jan 8;15:4.

Latifi R, Patel AS, Samson DJ,et al. The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections. Eur J Trauma Emerg Surg. 2019 Oct; 45(5):919-926.

Nawijn F, Houwert RM, van Wessem KPJ, et al. A 5-Year Evaluation of the Implementation of Triple Diagnostics for Early Detection of Severe Necrotizing Soft Tissue Disease: A Single-Center Cohort Study. World J Surg. 2019 Aug;43(8):1898-1905.

Yoon MA, Chung HW, Yeo Y, et al. Distinguishing necrotizing from non-necrotizing fasciitis: a new predictive scoring integrating MRI in the LRINEC score. Eur Radiol. 2019 Jul;29(7): 3414-3423.

Savage SA, Li SW, Utter GH, et al. The EGS grading scale for skin and soft-tissue infections is predictive of poor outcomes: a multicenter validation study. J Trauma Acute Care Surg. 2019 Apr;86(4):601-608.

Hadeed GJ, Smith J, O’Keeffe T, et al. Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience. J Emerg Trauma Shock. 2016 Jan-Mar;9(1):22-7.

Alayed KA, Tan C, Daneman N. Red Flags for Necrotizing Fasciitis: A Case Control Study. Int J Infect Dis. 2015 Jul;36:15-20. .