Department of Otolaryngology-Head and Neck Surgery, Harborview Medical Center and University of Washington Affiliated Hospitals, Seattle, Washington, USA.
Laryngoscope. 2012 Dec;122(12):2683-7. doi: 10.1002/lary.23680. Epub 2012 Sep 19.
OBJECTIVES/HYPOTHESIS: Cervical necrotizing fasciitis (CNF) is challenging to diagnose and associated with high morbidity and mortality. The objective of this study is to evaluate the utility of two laboratory-based diagnostic tools for distinguishing necrotizing from non-necrotizing infection when specifically applied to neck infection.
Retrospective review.
We reviewed 17 consecutive cases of CNF and 70 cases of non-necrotizing neck infection (cellulitis, phlegmon, abscess) occurring at our institution over a 10.75-year period. Cervical necrotizing fasciitis was confirmed by operative report documentation. Patient demographics, presenting characteristics, and outcomes were recorded.
Use of white blood cell count and serum sodium levels to predict cervical necrotizing fasciitis had a sensitivity of 24% (95% confidence interval [CI], 0.078-0.502), specificity of 81% (95% CI, 0.688-0.889), positive predictive value of 23% (95% CI, 0.054-0.401), and negative predictive value of 81% (95% CI, 0.769-0.857). A Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score of ≥ 6 had a sensitivity of 56% (95% CI, 0.227-0.847), specificity of 60% (95% CI, 0.274-0.863), positive predictive value of 25% (95% CI, 0.072-0.433), and negative predictive value of 85% (95% CI, 0.733-0.962).
Neither the LRINEC score nor the use of admission white blood cell count and sodium level were useful for distinguishing cervical necrotizing fasciitis from non-necrotizing neck infection.
目的/假设：颈坏死性筋膜炎（CNF）的诊断具有挑战性，且与高发病率和死亡率相关。本研究的目的是评估两种基于实验室的诊断工具在专门应用于颈部感染时，区分坏死性和非坏死性感染的效用。
回顾性研究。
我们回顾了 17 例在我院发生的连续 CNF 病例和 70 例非坏死性颈部感染（蜂窝织炎、痈、脓肿）病例，时间跨度为 10.75 年。颈坏死性筋膜炎通过手术报告记录得到确认。记录患者的人口统计学、临床表现和结局。
使用白细胞计数和血清钠水平预测颈坏死性筋膜炎的敏感性为 24%（95%置信区间[CI]，0.078-0.502），特异性为 81%（95% CI，0.688-0.889），阳性预测值为 23%（95% CI，0.054-0.401），阴性预测值为 81%（95% CI，0.769-0.857）。实验室坏死性筋膜炎风险指标（LRINEC）评分≥6 的敏感性为 56%（95% CI，0.227-0.847），特异性为 60%（95% CI，0.274-0.863），阳性预测值为 25%（95% CI，0.072-0.433），阴性预测值为 85%（95% CI，0.733-0.962）。
LRINEC 评分和入院时白细胞计数和钠水平均不能用于区分颈坏死性筋膜炎和非坏死性颈部感染。
