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{
    "pk": 9430,
    "title": "Inadequate Sensitivity of Laboratory Risk Indicator to Rule Out Necrotizing Fasciitis in the Emergency Department",
    "subtitle": null,
    "abstract": "Introduction:\n Necrotizing fasciitis (NF) is a life-threatening illness, particularly when surgical debridement is delayed. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was developed to identify patients at higher risk for NF. Despite limited information in this regard, the LRINEC score is often used to “rule out” NF if negative. We describe the sensitivity of the LRINEC score in emergency department (ED) patients for the diagnosis of NF.\nMethods:\n We conducted a chart review of ED patients in whom coding of hospital discharge diagnoses included NF. We employed standard methods to minimize bias. We used laboratory data to calculate the LRINEC score, and confirmed the diagnosis of NF via explicit chart review. We then calculated the sensitivity of a positive LRINEC score (standardly defined as six or greater) in our cohort. We examined the role of patient characteristics in the performance of the LRINEC score. Finally, we performed sensitivity analyses to estimate whether missing data for c-reactive protein (CRP) results were likely to impact our results.\nResults:\n Of 266 ED patients coded as having a discharge diagnosis of NF, we were able to confirm the diagnosis, by chart review, in 167. We were able to calculate a LRINEC score in only 80 patients (due to absence of an initial CRP value); an LRINEC score of 6 or greater had a sensitivity of 77%. Sensitivity analyses of missing data supported our finding of inadequate sensitivity to rule out NF. In sub-analysis, NF patients with concurrent diabetes were more likely to be accurately categorized by the LRINEC score.\nConclusion:\n Used in isolation, the LRINEC score is not sufficiently sensitive to rule out NF in a general ED population.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "necrotizing fasciitis"
        },
        {
            "word": "clinical decision instruments"
        }
    ],
    "section": "Health Outcomes",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/3b75942d",
    "frozenauthors": [
        {
            "first_name": "Elizabeth",
            "middle_name": "",
            "last_name": "Burner",
            "name_suffix": "",
            "institution": "Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Sean",
            "middle_name": "O.",
            "last_name": "Henderson",
            "name_suffix": "",
            "institution": "Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Guenevere",
            "middle_name": "",
            "last_name": "Burke",
            "name_suffix": "",
            "institution": "George Washington University, Department of Emergency Medicine, Washington, DC",
            "department": "None"
        },
        {
            "first_name": "Jeffrey",
            "middle_name": "",
            "last_name": "Nakashioya",
            "name_suffix": "",
            "institution": "Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Jerome",
            "middle_name": "R.",
            "last_name": "Hoffman",
            "name_suffix": "",
            "institution": "University of California Los Angeles, Department of Emergency Medicine, Los Angeles, California",
            "department": "None"
        }
    ],
    "date_submitted": "2015-10-28T18:56:52Z",
    "date_accepted": "2015-10-28T18:56:52Z",
    "date_published": "2016-04-26T07:00:00Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/9430/galley/5291/download/"
        }
    ]
}