ArticlePloS one2015
Improvement of a Clinical Score for Necrotizing Fasciitis: 'Pain Out of Proportion' and High CRP Levels Aid the Diagnosis.
Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 3 of them syntheses that pooled it.
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Who cites it
42 citing papers in PubMed, 3 syntheses or guidelines pooled it, 108 citations in OpenAlex.
- A systematic review showing the lack of diagnostic criteria and tools developed for lower-limb cellulitis.The British journal of dermatology · 2019Pooled it
- A systematic review of necrotising fasciitis in children from its first description in 1930 to 2018.BMC infectious diseases · 2019Pooled it
- Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature.Annals of the Royal College of Surgeons of England · 2017Pooled it
- Necrotizing Fasciitis in Switzerland: Risk Factors and Clinical Outcomes Based on a 12-Year Retrospective Study.Journal of clinical medicine · 2026Article
- Imaging and clinical features of emphysematous osteomyelitis.Skeletal radiology · 2026Article
- Diagnostic strategies in necrotizing soft tissue infections: from clinical scores to multi-omics and machine learning.Burns & trauma · 2026Review
- Clinical Nomogram for Early Identification of Necrotizing Soft Tissue Infections: Development and Internal Validation in Hospitalized Patients.Infection and drug resistance · 2026Article
- Article
- Validation of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and establishment of novel score in Japanese patients with necrotizing fasciitis (J-LRINEC score).The Journal of dermatology · 2025Article
- Neutrophil diversity and function in health and disease.Signal transduction and targeted therapy · 2024Review
- The intricate pathogenicity of Group AVirulence · 2024Review
- Real-time identification of life-threatening necrotizing soft-tissue infections using indocyanine green fluorescence imaging.Journal of biomedical optics · 2024Observational
- Pediatric Necrotizing Fasciitis.Journal of the Pediatric Orthopaedic Society of North America · 2023Review
- Initial skin necrosis presentation at emergency room was associated with fulminant clinical course and mortality in patients with Vibrio necrotizing fasciitis.Scientific reports · 2023Article
- The Subacute Necrotizing Fasciitis: The Forgotten form of this Life-threatening Infection. A Case Report.Journal of orthopaedic case reports · 2023Article
- Bilateral non-contiguous necrotizing fasciitis of the lower extremities.Clinical case reports · 2023Article
- Clinical and Laboratory Parameters for Differential Diagnosis of Necrotizing Faciitis and Cellulitis.Sisli Etfal Hastanesi tip bulteni · 2023Article
- Necrotizing Soft Tissue Infection Post VASER-Assisted Liposuction and Lipofilling: A Case Report.Aesthetic surgery journal. Open forum · 2023Article
- Outcome of necrotizing fasciitis and Fournier's gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years.World journal of emergency surgery : WJES · 2022Article
- Cellulitis: A Review of Current Practice Guidelines and Differentiation from Pseudocellulitis.American journal of clinical dermatology · 2022Review
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Necrotizing fasciitis (NF) is a rare mono-/polymicrobial skin infection that spreads to underlying tissues. NF is quickly progressing and leads to life threatening situations. Immediate surgical debridement together with i.v. antibiotic administration is required to avoid fatal outcome. Early diagnosis is often delayed due to underestimation or confusion with cellulitis. We now compared the initial clinical and laboratory presentation of NF and cellulitis in detail to assess if a typical pattern can be identified that aids timely diagnosis of NF and avoidance of fatal outcome. 138 different clinical and laboratory features of 29 NF patients were compared to those of 59 age- and gender matched patients with severe erysipelas requiring a subsequent hospitalization time of ≥10 days. Differences in clinical presentation were not obvious; however, NF patients suffered significantly more often from strong pain. NF patients exhibited dramatically elevated CRP levels (5-fold, p>0.001). The overall laboratory risk indicator for necrotizing fasciitis (LRINEC) score was significantly higher in NF patients as compared to cellulitis. However, a modification of the score (alteration of laboratory parameters, addition of clinical parameters) led to a clear improvement of the score with a higher positive predictive value without losing specificity. In summary, clinical differentiation of NF from cellulitis appears to be hard. 'Pain out of proportion' may be an early sign for NF. An improvement of the LRINEC score emphasizing only relevant laboratory and clinical findings as suggested may aid the early diagnosis of NF in the future leading to improvement of disease outcome by enabling rapid adequate therapy.
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