red flags for necrotizing fasciitis: a case control study

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ID: 172801
2015
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Abstract
Objective: to examine the diagnostic accuracy of traditional ‘red flags’ for necrotizing fasciitis (NF) on history and physical examination. Methods: retrospective study of all cases of NF admitted to a large tertiary care hospital between January 1 2004 and December 31 2013, each matched to two control patients with cellulitis. We determined the diagnostic test characteristics of clinical features for distinguishing NF from cellulitis, with emphasis on positive (LR+) and negative (LR-) likelihood ratios. Results: There were no individual findings with sufficient sensitivity to rule out NF (sensitivity ≤ 85% and LR- ≥ 0.5 for all findings). The clinical features that most significantly increased the odds of NF were recent surgery (LR+ 7.0) pain-out-of-proportion (LR+ 4.5), diarrhea (LR+ 6.0), hypotension (LR+ 8.0), altered mental status (LR+ 3.3), erythema progressing beyond margins (LR+3.1), fluctuance (LR+ 5.0), hemorrhagic bullae (LR+ 8.0) and skin necrosis (LR+ 30.0). Each individual finding conferred low sensitivity, but absence of all nine ruled out NF (LR- 0.04). The presence of >=3 findings ruled in NF (LR+ undefined). Conclusions: When considered together, the traditional ‘red flags’ for NF may be sufficient to rule in or rule out the diagnosis. If future prospective studies validate these findings, there will be a potential opportunity to expedite NF diagnosis and improve patient outcomes.
Reference Key
alayed2015internationalred Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Khalid Al Alayed;Charlie Tan;Nick Daneman
Journal israel journal of chemistry
Year 2015
DOI
10.1016/j.ijid.2015.04.021
URL
http://www.sciencedirect.com/science/article/pii/S1201971215001174
Keywords
diagnosis necrotizing fasciitis diagnostic accuracy

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