Zemplenyi K, Lopez B, Sardesai M, Dillon J K
Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA, USA.
School of Dentistry, University of Washington, Seattle, WA, USA.
Int J Oral Maxillofac Surg. 2017 Feb;46(2):181-188. doi: 10.1016/j.ijom.2016.09.016. Epub 2016 Oct 15.
The progression of odontogenic infections to necrotizing soft tissue infections (NSTIs) is unknown. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is used to predict risk of NSTI. This study aimed to (1) estimate the frequency at which odontogenic infections progress to NSTIs, (2) measure the value of LRINEC in predicting progression to NSTI, and (3) estimate the charges associated with managing NSTIs. This retrospective cohort study enrolled all subjects admitted for the management of odontogenic infections from 2001 to 2013. The primary predictor was the LRINEC score. The primary outcome was NSTI. The secondary outcome was billing charges. Descriptive and bivariate statistical analyses were performed, with significance set at a P-value of <0.05. Of 479 odontogenic infections, (1.0%) progressed to NSTI. The mean LRINEC for NSTI was 5.8 and for odontogenic infection was 3.4 (P=0.043). LRINEC parameters for the prediction of NSTIs had 60% sensitivity, 68.4% specificity, 20% positive predictive value, and 92.9% negative predictive value. The mean charge for NSTI was $319,337 and for odontogenic infections was $19,291 (P=0.051). One percent of odontogenic infections progressed to NSTIs. The LRINEC score was not able to identify all NSTIs. NSTIs are 16 times more costly.
牙源性感染进展为坏死性软组织感染（NSTIs）的过程尚不清楚。坏死性筋膜炎实验室风险指标（LRINEC）评分用于预测NSTI的风险。本研究旨在（1）估计牙源性感染进展为NSTIs的频率，（2）衡量LRINEC在预测进展为NSTI方面的价值，以及（3）估计与管理NSTIs相关的费用。这项回顾性队列研究纳入了2001年至2013年因牙源性感染入院治疗的所有患者。主要预测指标是LRINEC评分。主要结局是NSTI。次要结局是计费费用。进行了描述性和双变量统计分析，显著性设定为P值<0.05。在479例牙源性感染中，1.0%进展为NSTI。NSTI的平均LRINEC为5.8，牙源性感染的平均LRINEC为3.4（P = 0.043）。预测NSTIs的LRINEC参数敏感性为60%，特异性为68.4%，阳性预测值为20%，阴性预测值为92.9%。NSTI的平均费用为319,337美元，牙源性感染的平均费用为19,291美元（P = 0.051）。1%的牙源性感染进展为NSTIs。LRINEC评分无法识别所有NSTIs。NSTIs的费用高出16倍。
