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Rathore A, Reich DA, Qadir N, Harrison C. A Case Report of Culture-Negative Necrotizing Fasciitis With Low Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score: A Diagnostic Dilemma. Cureus 2023; 15:e37268. [PMID: 37162772 PMCID: PMC10164443 DOI: 10.7759/cureus.37268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023] Open
Abstract
The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is a diagnostic tool used to help clinicians identify necrotizing fasciitis (NF) in its early stages. This tool uses six laboratory values including the patient's white blood cell count, C-reactive protein level, serum sodium level, creatinine level, and hemoglobin level to help with risk stratification. Each of these laboratory values is assigned a point value and the total score is used to determine the likelihood that a patient has NF, with a score of 6 or higher considered to be strongly indicative. The LRINEC score has gained popularity in recent years, having been included in guidelines and society recommendations for the management of NF. However, some studies have challenged the validity of the LRINEC score. Prompt and accurate diagnosis of NF is imperative given the associated mortality rate, which can be as high as 30%-40%, especially if the diagnosis is delayed. We present a case of a patient with a delayed diagnosis of NF that was initially missed in the early stages in the setting of a low LRINEC, however, growing clinical suspicion eventually led to an accurate diagnosis and management.
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Affiliation(s)
- Azeem Rathore
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Daniel A Reich
- Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Nadim Qadir
- Internal Medicine, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Charles Harrison
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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McLaughlin C, Zagory JA, Fenlon M, Park C, Lane CJ, Meeker D, Burd RS, Ford HR, Upperman JS, Jensen AR. Timing of mortality in pediatric trauma patients: A National Trauma Data Bank analysis. J Pediatr Surg 2018; 53:344-351. [PMID: 29111081 PMCID: PMC5828917 DOI: 10.1016/j.jpedsurg.2017.10.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND/PURPOSE The classic "trimodal" distribution of death has been described in adult patients, but the timing of mortality in injured children is not well understood. The purpose of this study was to define the temporal distribution of mortality in pediatric trauma patients. METHODS A retrospective cohort of patients with mortality from the National Trauma Data Bank (2007-2014) was analyzed. Categorical comparison of 'dead on arrival', 'death in the emergency department', and early (≤24h) or late (>24h) inpatient death was performed. Secondary analyses included mortality by pediatric age, predictors of early mortality, and late complication rates. RESULTS Children (N=5463 deaths) had earlier temporal distribution of death compared to adults (n=104,225 deaths), with 51% of children dead on arrival or in ED compared to 44% of adults (p<0.001). For patients surviving ED resuscitation, children and adolescents had a shorter median time to death than adults (1.2 d and 0.8 days versus 1.6 days, p<0.001). Older age, penetrating mechanism, bradycardia, hypotension, tube thoracostomy, and thoracotomy were associated with early mortality in children. CONCLUSIONS Injured children have higher incidence of early mortality compared to adults. This suggests that injury prevention efforts and strategies for improving early resuscitation have potential to improve mortality after pediatric injury. LEVEL OF EVIDENCE Level III: Retrospective cohort study.
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Affiliation(s)
- Cory McLaughlin
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90027.
| | - Jessica A. Zagory
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027
| | - Michael Fenlon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90027; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033.
| | - Caron Park
- Southern California Clinical and Translational Science Institute (SC-CTSI), Los Angeles, CA 90033; Department of Preventative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033.
| | - Christianne J Lane
- Southern California Clinical and Translational Science Institute (SC-CTSI), Los Angeles, CA 90033; Department of Preventative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033.
| | - Daniella Meeker
- Southern California Clinical and Translational Science Institute (SC-CTSI), Los Angeles, CA 90033; Department of Preventative Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033.
| | - Randall S. Burd
- Division of Trauma and Burn Surgery, Children’s National Medical Center, Washington, DC 20310
| | - Henri R. Ford
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027,Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033
| | - Jeffrey S. Upperman
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027,Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033
| | - Aaron R. Jensen
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027,Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033
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