LO50: Necrotizing soft tissue infection: diagnostic accuracy of physical examination, imaging and LRINEC score a systematic review and meta-analysis

摘要: Introduction: Necrotizing soft tissue infection (NSTI), a potentially life-threatening diagnosis, is often not immediately recognized by clinicians. Delays in diagnosis are associated with increased morbidity and mortality. We sought to summarize compare the accuracy of physical exam, imaging, Laboratory Risk Indicator Fasciitis (LRINEC) Score used confirm suspected NSTI adult patients skin infections. Methods: searched Medline, Embase 4 other databases from inception through November 2017. included only English studies (randomized controlled trials, cohort case-control studies) that reported diagnostic testing or LRINEC Score. Outcome was confirmed surgery histopathology. Two reviewers independently screened extracted data. assessed risk bias using Quality Assessment Diagnostic Accuracy Studies 2 criteria. summary estimates were obtained Hierarchical Summary Receiver Operating Characteristic model. Results: 21 (n=6,044) meta-analysis. Of exam signs, pooled sensitivity specificity for fever (49.4% [95% CI: 41.4-57.5], 78.0% 52.2-92.0]), hemorrhagic bullae (30.8% 16.2-50.6], 94.2% 82.9-98.2]) hypotension (20.8% 7.7-45.2], 97.9% 89.1-99.6]) generated. Computed tomography (CT) had 88.5% 55.5-97.9] 93.3% 80.8-97.9] specificity, while plain radiography 48.9% 24.9-73.4] 94.0% 63.8-99.3] specificity. Finally, 6 (traditional threshold) 67.5% 48.3-82.3] 86.7% 77.6-92.5] 8 94.9% 89.4-97.6] but 40.8% 28.6-54.2] sensitivity. Conclusion: The absence any one feature (e.g. hypotension) sufficient rule-out NSTI. CT superior radiography. poor sensitivity, suggesting low score For NSTI, further evaluation warranted. While no single test sensitive, high-risk features should receive early surgical consultation definitive management.