Fournier gangrene diagnostic criteria: Difference between revisions
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==Overview== | ==Overview== | ||
==Diagnosis== | |||
The diagnosis of Fournier gangrene is primarily based on clinical findings. The diagnosis is based on following criteria:<ref name="pmid18087630">{{cite journal| author=Kuo CF, Wang WS, Lee CM, Liu CP, Tseng HK| title=Fournier's gangrene: ten-year experience in a medical center in northern Taiwan. | journal=J Microbiol Immunol Infect | year= 2007 | volume= 40 | issue= 6 | pages= 500-6 | pmid=18087630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18087630 }} </ref> | |||
*Soft tissue infections with involvement of the [[scrotum]], [[perineum]] and perianal areas | |||
*Presence of air infiltrating the [[subcutaneous tissue]] (demonstrated by physical examination or radiological findings) | |||
*Surgical findings of [[gangrene|gangrenous]] and [[necrosis|necrotic tissue]] | |||
*Histologically proven [[necrotizing fasciitis]]. | |||
===Diagnostic Criteria=== | |||
'''The Uludag Fournier gangrene severity index''' | |||
{| class="wikitable" style="border: 2; background: none;" | |||
! colspan="1" rowspan="2" style="border: 1; background: 1;"| Physiologic Variables | |||
! colspan="4" rowspan="1"| High Abnormal Values | |||
! colspan="1" rowspan="1"| Normal | |||
! colspan="4" rowspan="1"| Low Abnormal Values | |||
|- colspan="1" rowspan="2" style="border: 1; background: 1;" | |||
! +4 || +3 || +2 || +1 || 0 || +1 || +2 || +3 || + 4 | |||
|- | |||
! rowspan="1" style="border: 1; background: none;"| Temperature | |||
| >41 || 39-40.0|| ||38.5-39 || 36-38.4 || 34-35.9 || 32-33.9 || 30-31.9 || <29.9 | |||
|- | |||
! rowspan="1" style="border: 1; background: none;"| Heart Rate | |||
| >180 || 140-179 || 110-139 || || 70-109 || || 55-69 || 40-54 || <39 | |||
|- | |||
! rowspan="1" style="border: 1; background: none;"| Respiratory Rate | |||
| >50 || 35-49 || ||25-34||12-24||10-11||6-9|| || <5 | |||
|- | |||
! rowspan="1" style="border: 1; background: none;"| Serum Sodium (mmol/L) | |||
| >180 ||160-179 ||155-159 ||150-154 ||130-149 || ||120-129 ||111-119 ||<110 | |||
|- | |||
! rowspan="1" style="border: 1; background: none;"| Serum Potassium (mmol/L) | |||
|>7 ||6-6.9 || || 5.5-5.9 ||3.5-5.4 ||3-3.4 ||2.5-2.9 || ||<2.5 | |||
|- | |||
! rowspan="1" style="border: 1; background: none;"| Serum Creatinine<br>(mg/100/ml*2 for acute renal failure) | |||
|>3.5 ||2-3.4 ||1.5-1.9 || ||0.6-1.4 || ||<0.6 || || | |||
|- | |||
! rowspan="1" style="border: 1; background: none;"| Hematocrit | |||
| >60|| ||50-59.9 ||46-49.9 ||30-45.9 || ||20-29.9 || ||<20 | |||
|- | |||
! rowspan="1" style="border: 1; background: none;"| WBC (Total/mm*1000) | |||
| >40|| ||20-39.9 ||15-19.9 ||3-14.9 || ||1-2.9 || || <1 | |||
|- | |||
! rowspan="1" style="border: 1; background: none;"| Serum Bicarbonate (Venous,mmol/l) | |||
|>52 ||41-51.9 || ||32-40.9 ||22-31.9 || ||18-21.9 ||15-17.9 || <15 | |||
|} | |||
*Score >10.5 indicates 96% probability of death<ref name="pmid18563618">{{cite journal| author=Kabay S, Yucel M, Yaylak F, Algin MC, Hacioglu A, Kabay B et al.| title=The clinical features of Fournier's gangrene and the predictivity of the Fournier's Gangrene Severity Index on the outcomes. | journal=Int Urol Nephrol | year= 2008 | volume= 40 | issue= 4 | pages= 997-1004 | pmid=18563618 | doi=10.1007/s11255-008-9401-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18563618 }} </ref> | |||
*Score ≤10.5 indicates 96% probability of survival | |||
According to Loar and colleagues, the severity of Fournier gangrene is: | |||
*Score ≥9 indicates 46% probability of death | |||
*Score <9 indicates 96% probability of survival | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 21:05, 6 September 2017
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Steven C. Campbell, M.D., Ph.D.; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[1]; Jesus Rosario Hernandez, M.D. [2]
Overview
Diagnosis
The diagnosis of Fournier gangrene is primarily based on clinical findings. The diagnosis is based on following criteria:[1]
- Soft tissue infections with involvement of the scrotum, perineum and perianal areas
- Presence of air infiltrating the subcutaneous tissue (demonstrated by physical examination or radiological findings)
- Surgical findings of gangrenous and necrotic tissue
- Histologically proven necrotizing fasciitis.
Diagnostic Criteria
The Uludag Fournier gangrene severity index
| Physiologic Variables | High Abnormal Values | Normal | Low Abnormal Values | ||||||
|---|---|---|---|---|---|---|---|---|---|
| +4 | +3 | +2 | +1 | 0 | +1 | +2 | +3 | + 4 | |
| Temperature | >41 | 39-40.0 | 38.5-39 | 36-38.4 | 34-35.9 | 32-33.9 | 30-31.9 | <29.9 | |
| Heart Rate | >180 | 140-179 | 110-139 | 70-109 | 55-69 | 40-54 | <39 | ||
| Respiratory Rate | >50 | 35-49 | 25-34 | 12-24 | 10-11 | 6-9 | <5 | ||
| Serum Sodium (mmol/L) | >180 | 160-179 | 155-159 | 150-154 | 130-149 | 120-129 | 111-119 | <110 | |
| Serum Potassium (mmol/L) | >7 | 6-6.9 | 5.5-5.9 | 3.5-5.4 | 3-3.4 | 2.5-2.9 | <2.5 | ||
| Serum Creatinine (mg/100/ml*2 for acute renal failure) |
>3.5 | 2-3.4 | 1.5-1.9 | 0.6-1.4 | <0.6 | ||||
| Hematocrit | >60 | 50-59.9 | 46-49.9 | 30-45.9 | 20-29.9 | <20 | |||
| WBC (Total/mm*1000) | >40 | 20-39.9 | 15-19.9 | 3-14.9 | 1-2.9 | <1 | |||
| Serum Bicarbonate (Venous,mmol/l) | >52 | 41-51.9 | 32-40.9 | 22-31.9 | 18-21.9 | 15-17.9 | <15 | ||
- Score >10.5 indicates 96% probability of death[2]
- Score ≤10.5 indicates 96% probability of survival
According to Loar and colleagues, the severity of Fournier gangrene is:
- Score ≥9 indicates 46% probability of death
- Score <9 indicates 96% probability of survival
References
- ↑ Kuo CF, Wang WS, Lee CM, Liu CP, Tseng HK (2007). "Fournier's gangrene: ten-year experience in a medical center in northern Taiwan". J Microbiol Immunol Infect. 40 (6): 500–6. PMID 18087630.
- ↑ Kabay S, Yucel M, Yaylak F, Algin MC, Hacioglu A, Kabay B; et al. (2008). "The clinical features of Fournier's gangrene and the predictivity of the Fournier's Gangrene Severity Index on the outcomes". Int Urol Nephrol. 40 (4): 997–1004. doi:10.1007/s11255-008-9401-4. PMID 18563618.