Review of Diagnostic Tools for Necrotizing Soft Tissue Infections

The journal Annals of Emergency Medicine recently published an article reviewing the tools used to diagnose necrotizing soft tissue infection. 

Necrotizing soft tissue infections necessitate rapid diagnosis and fast administration of broad-spectrum antibiotic treatment and surgical debridement. The standard diagnostic option is physical observation during surgical exploration.

Researchers performed database searches for the terms “necrotizing skin and soft tissue infection,” “gas gangrene,” and “Fournier’s gangrene” and selected English-language research articles that included 23 studies (comprised of 16 retrospective cohort studies, 2 prospective cohort studies, and 5 retrospective case-control studies). 

Meta-analysis was performed on various studies with different patient populations to ascertain the diagnostic accuracy of physical examinations, imaging modalities, and laboratory risk indicator for necrotizing fasciitis (LRINEC) scores. Results showed the limited utility of the diagnostic tools. 

Computed tomography was the most sensitive diagnostic tool; physical examinations and radiography demonstrated poorer sensitivity. The LRINEC score held diagnostic accuracy but lacked sensitivity.

The investigators identified 3 limitations: study quality related to lack of detailed study designs; clinical heterogeneity across included studies; and the lack of review results for other diagnostic tools, such as ultrasonography or individual components of LRINEC score. This study reinforced the need for clinician’s discretion in the diagnosis of necrotizing soft tissue infection until better tools are developed.

Reference

April MD and Long B. What is the accuracy of physical examination, imaging, and the LRINEC score for the diagnosis of necrotizing soft tissue infection [published online August 13, 2018] Ann Emerg Med. doi:10.1016/j.annemergmed.2018.06.029