LRINEC_Score_guideline v.1
LRINEC Score for Necrotizing Soft Tissue Infection.
To screen for necrotizing soft tissue infections.
Use to screen for necrotizing soft tissue infections in patients with a concerning history or physical exam (pain out of proportion to exam, rapidly progressive cellulitis, for example) as well as patient with an unconcerning story (can provide some reassurance if the score is very low). Variables and related points: - CRP (mg/L): <150=0, ≥150=4 - WBC per mm³: <15=0, 15-25=1, >25=2 - Hemoglobin (g/dL): >13.5=0, 11-13.5=1, <11=2 - Sodium: ≥135=0, <135=2 - Creatinine: ≤ 1.6 mg/dL / 141 µmol/L=0, >1.6 mg/dL / 141 µmol/L=2 - Glucose: ≤180 mg/dL / 10 mmol/L=0, >180 mg/dL / 10 mmol/L=1 LRINEC score= Addition of the selected points. Interpretations: LRINEC score<6: - Advice: If high suspicion for necrotizing fasciitis through clinical history and physical exam, do not calculate a LRINEC score and go straight to operative debridement. - Management: Consider IV antibiotics and serial labs to monitor response to treatment. Scores <6 were low risk — but not no risk — for necrotizing soft tissue infections. LRINEC score>=6, <8: -Advice: If high suspicion for necrotizing fasciitis through clinical history and physical exam, do not calculate a LRINEC score and go straight to operative debridement. - Management: Scores of 6 had a PPV of 92% and NPV of 96% for NSTIs. Intermediate Risk for Necrotizing Soft Tissue Infection. - Critical Actions: Consider urgent MRI, frozen section biopsy or finger test (manual probing of area in question under local anesthesia). If positive, emergent operative debridement. If negative, IV antibiotics, close observation, serial labs. LRINEC score>=8: - Advice: If high suspicion for necrotizing fasciitis through clinical history and physical exam, do not calculate a LRINEC score and go straight to operative debridement. - Management: High Risk for Necrotizing Soft Tissue Infection. Scores of 8 had a PPV of 93.4% for NSTIs. - Critical Actions: Work-up as suggested or emergent operative debridement.
Not to use to rule out potential necrotizing soft tissue infection.
1. Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004 Jul;32(7):1535-41. PubMed PMID: 15241098. 2. Chun-I Liao, Yi-Kung Lee, Yung-Cheng Su, Chin-Hsiang Chuang, Chun-Hing Wong. Validation of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for early diagnosis of necrotizing fasciitis. Tzu Chi Medical Journal - June 2012 (Vol. 24, Issue 2, Pages 73-76, DOI: 10.1016/j.tcmj.2012.02.009) 3. Neeki MM, Dong F, Au C, et al. Evaluating the Laboratory Risk Indicator to Differentiate Cellulitis from Necrotizing Fasciitis in the Emergency Department. West J Emerg Med. 2017;18(4):684-689. 4. Su YC, et al. Laboratory risk indicator for necrotizing fasciitis score and the outcomes. ANZ J. Surg. 2008; 78:968-72. 5. Holland MJ. Application of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) score to patients in a tropical tertiary referral center. Anaesth Intensive Care 2009; 37:588-92. 6. 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. 2018.
OBSERVATION.lab_test_c_reactive_protein.v1, OBSERVATION.lab_test-full_blood_count.v1, OBSERVATION.lab_test-serum_sodium.v1, OBSERVATION.lab_test_creatinine.v1, OBSERVATION.lab_test_glucose.v1, OBSERVATION.lrinec_score.v0
