Diagnostic accuracy of LRINEC score and vitals in Necrotising skin infection in clinical Surgical Scar Incision Infection: A meta-analysis

Abstract

AbstractBackgroundNecrotizing soft tissue infection (NSTI) is a potentially fatal skin and soft tissue infection, characterized by fulminant tissue damage, systemic signs of toxicity, and high mortality with case fatality rates ranging from 14% to 41% over the last two decades. It can be challenging to diagnose NF in its initial phases as it frequently presents symptoms that are similar to those of other non-necrotic SSTIs, such as cellulitis. It is unclear how the different diagnostic imaging modalities should be used to evaluate patients who have a suspected NSTI and there are concerns about their accuracy and potential delays in surgical intervention. Therefore, we aimed to gather data on the sensitivity and specificity of physical findings of fever, hypotension as well as imaging techniques such as ultrasound (USG) and computed tomography (CT) scans, and the LRINEC score, in detecting Necrotizing Soft Tissue Infections (NSTI) in patients.MethodsMedical literature was comprehensively searched and reviewed without restrictions to particular study designs, or publication dates using PubMed, Cochrane Library, and Google Scholar databases for all relevant literature. The extraction of necessary data proceeded after specific inclusion and exclusion criteria were applied. In this Meta-Analysis, a total of 49 RCTs with an aggregate of 11,520 cases were handpicked. wherein two writers independently assessed the caliber of each study as well as the use of the Cochrane tool for bias risk apprehension. The statistical software packages RevMan (Review Manager, version 5.3), SPSS (Statistical Package for the Social Sciences, version 20), and Excel in Stata 14 were used to perform the statistical analyses.ResultsWe calculated the sensitivity and specificity for each of the parameters. Here, USG has a sensitivity of 0.556 and specificity of 0.879, CT has a sensitivity of 0.932 and specificity of 0.849, and LRINEC Score >= 6 has a sensitivity of 0.59 and specificity of 0.849. we also calculated the same for physical signs like fever and hypotension.Conclusionwe conclude that physical signs like fever and hypotension and LRINEC Score >= 6 are not advisable indicators, however, CT shows significant superior modality but it is not a cost-effective solution. USG is relatively reliable and cost-effective for the early diagnosis of NSTI.