Fournier gangrene diagnostic criteria
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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.