title: Fournier's gangrene: a model for early prediction.
abstract: Early diagnosis remains the cornerstone of management of Fournier's gangrene. As a result of variable progression of disease, identifying early predictors of necrosis becomes a diagnostic challenge. We present a scoring system based on objective admission criteria, which can help distinguish Fournier's gangrene from nonnecrotizing scrotal infections. Ninety-six patients were identified, 38 diagnosed with Fournier's gangrene and 58 diagnosed with scrotal cellulitis or abscess. Statistical analyses comparing admission vital signs, laboratory values, and imaging studies were performed and Classification and Regression Tree analysis was used to construct a scoring system. Admission heart rate greater than 110 beats/minute, serum sodium less than 135 mmol/L, blood urea nitrogen greater than 15 mg/dL, and white blood cell count greater than 15 × 10(3)/μL were significant predictors of Fournier's gangrene. Using a threshold score of two or greater, our model differentiates patients with Fournier's gangrene from those with nonnecrotizing infections with a sensitivity of 84.2 per cent. Only 34.2 per cent of patients with Fournier's gangrene had hard signs of necrotizing infection on admission, which were not observed in patients with nonnecrotizing infections. Objective admission criteria assist in distinguishing Fournier's gangrene from scrotal cellulitis or abscess. In situations in which results of the physical examination are ambiguous, this scoring system can heighten the index of suspicion for Fournier's gangrene and prompt rapid surgical intervention.
authors.affiliation: David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Roland
authors.initials: R
authors.lastname: Palvolgyi
authors.forename: Amy H
authors.initials: AH
authors.lastname: Kaji
authors.forename: Javier
authors.initials: J
authors.lastname: Valeriano
authors.forename: David
authors.initials: D
authors.lastname: Plurad
authors.forename: Jacob
authors.initials: J
authors.lastname: Rajfer
authors.forename: Christian
authors.initials: C
authors.lastname: de Virgilio
mesh_terms: D000038:Abscess / Q000175:diagnosis*; D000328:Adult; D002481:Cellulitis / Q000175:diagnosis*; D003646:Debridement; D003661:Decision Support Techniques; D003663:Decision Trees; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D018934:Fournier Gangrene / Q000175:diagnosis* / Q000601:surgery; D005832:Genital Diseases, Male / Q000175:diagnosis*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014845:Vulvar Diseases / Q000175:diagnosis*