title: Laboratory evaluation for pediatric patients with suspected necrotizing soft tissue infections: A case-control study.
abstract: OBJECTIVE
  Optimal outcomes for necrotizing soft tissue infections (NSTI) depend on rapid diagnosis and management. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is a validated diagnostic tool for adult NSTI, but its value for children remains unknown. We hypothesized that modification of the LRINEC score may increase its diagnostic accuracy for pediatric NSTI.
  
  
  METHODS
  We performed a case-control study of pediatric patients (age <18) with NSTI (cases) and patients with severe soft tissue infections prompting surgical consultation (controls). The LRINEC score was calculated for cases and controls and compared to a modified, pediatric LRINEC (P-LRINEC) score. Diagnostic accuracy was analyzed through receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  From 2010 to 2014, 20 cases and 20 controls were identified at two children's hospitals. Median LRINEC score was 3.5 (1-8) for cases and 2 (1-7) for controls (p=0.03). The P-LRINEC was comprised of serum CRP >20 (sensitivity=95% (95%CI 79-100%)) and serum sodium <135 (specificity=95% (95%CI 82-100%)). Area under ROC curves was 0.70 (95%CI 0.54-0.87) for the LRINEC score and 0.84 (95%CI 0.72-0.96) for the P-LRINEC score (p=0.06).
  
  
  CONCLUSIONS
  The P-LRINEC is a simplified version of the LRINEC score utilizing only CRP and sodium and may provide superior accuracy in predicting pediatric NSTI.
authors.affiliation: Department of Pediatric Surgery, Children's Memorial Hermann Hospital, University of Texas McGovern Medical School, Houston, TX, USA.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Putnam
authors.affiliation: Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
authors.forename: Morgan K
authors.initials: MK
authors.lastname: Richards
authors.affiliation: Division of Pediatric Plastic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
authors.forename: Brinkley K
authors.initials: BK
authors.lastname: Sandvall
authors.affiliation: Division of Pediatric Plastic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hopper
authors.affiliation: Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
authors.forename: John H T
authors.initials: JH
authors.lastname: Waldhausen
authors.affiliation: Department of Pediatric Surgery, Children's Memorial Hermann Hospital, University of Texas McGovern Medical School, Houston, TX, USA. Electronic address: matthew.t.harting@uth.tmc.edu.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Harting
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D019115:Fasciitis, Necrotizing / Q000175:diagnosis*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000175:diagnosis*
keywords: Lab risk indicator for necrotizing fasciitis; Necrotizing fasciitis; Necrotizing soft tissue infection; Pediatric infection