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.”

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.