{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T06:14:32Z","timestamp":1793340872077,"version":"4.5.0"},"reference-count":10,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2019,6,18]],"date-time":"2019-06-18T00:00:00Z","timestamp":1560816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,6,18]],"date-time":"2019-06-18T00:00:00Z","timestamp":1560816000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2019,6,18]],"date-time":"2019-06-18T00:00:00Z","timestamp":1560816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2019,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system was developed to aid the diagnosis of necrotizing fasciitis and guide management [1].<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To validate the LRINEC score and identify clinical predictors to develop a refined diagnostic scoring tool for the diagnosis of necrotizing fasciitis at Middlemore Hospital, New Zealand.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective case\u2013control study of patients admitted to Middlemore Hospital with necrotizing fasciitis and severe cellulitis between January 2000 and December 2010. The LRINEC scores at admission were evaluated for performance in discriminating between cases of necrotizing fasciitis and severe cellulitis. Cases and controls were randomized into developmental and validation cohorts. Univariate and multivariate logistic regression analysis of demographic, clinical, and laboratory variables for the diagnosis of necrotizing fasciitis was performed. The identified independent predictors were used to develop a new diagnostic scoring tool.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The area under the receiver operating characteristic curve (C\u2010statistic) of a LRINEC score \u22656 for the diagnosis of necrotizing fasciitis was 0.679. The newly developed SIARI score [Site other than the lower limb, Immunosuppression, Age\u2009&lt;\u200960 years, Renal impairment (creatinine\u2009&gt;\u2009141), and Inflammatory markers (CRP\u2009\u2265\u2009150, WCC\u2009&gt;\u200925] demonstrated superior diagnostic ability compared with the LRINEC score in both the developmental (C\u2010statistic: 0.832 vs. 0.691, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and validation cohorts (C\u2010statistic: 0.847 vs. 0.667, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The LRINEC score exhibited only modest discriminative performance in this cohort, while the SIARI score is a simplified tool that demonstrates superior diagnostic ability for detecting necrotizing fasciitis. Future external validation studies are required to confirm the trends observed in this study.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-019-05061-4","type":"journal-article","created":{"date-parts":[[2019,6,18]],"date-time":"2019-06-18T16:04:46Z","timestamp":1560873886000},"page":"2393-2400","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["The SIARI Score: A Novel Decision Support Tool Outperforms LRINEC Score in Necrotizing Fasciitis"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1904-835X","authenticated-orcid":false,"given":"Benjamin I.","family":"Cribb","sequence":"first","affiliation":[{"name":"Department of General Surgery Middlemore Hospital 100 Hospital Road, Otahuhu 2025 Auckland New Zealand"},{"name":"Epworth Hospital 89 Bridge Road 3121 Richmond VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T. M.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of General Surgery Middlemore Hospital 100 Hospital Road, Otahuhu 2025 Auckland New Zealand"},{"name":"Department of Medicine The University of Auckland 85 Park Rd, Grafton 1023 Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suheelan","family":"Kulasegaran","sequence":"additional","affiliation":[{"name":"Department of General Surgery Middlemore Hospital 100 Hospital Road, Otahuhu 2025 Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg D.","family":"Gamble","sequence":"additional","affiliation":[{"name":"Department of Medicine The University of Auckland 85 Park Rd, Grafton 1023 Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew D.","family":"MacCormick","sequence":"additional","affiliation":[{"name":"Department of General Surgery Middlemore Hospital 100 Hospital Road, Otahuhu 2025 Auckland New Zealand"},{"name":"Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences The University of Auckland 2025 Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,6,18]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000129486.35458.7D"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.13232"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkq362"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcmj.2012.02.009"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000094223.92746.56"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.13895"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X0903700416"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.5704\/MOJ.1707.005"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2016.2.29069"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2017.00005"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-019-05061-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-019-05061-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-019-05061-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-019-05061-4","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,7]],"date-time":"2024-01-07T16:00:46Z","timestamp":1704643246000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-019-05061-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,18]]},"references-count":10,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2019,10,15]]}},"alternative-id":["10.1007\/s00268-019-05061-4"],"URL":"https:\/\/doi.org\/10.1007\/s00268-019-05061-4","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,18]]},"assertion":[{"value":"18 June 2019","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This retrospective study was conducted following institutional ethics committee approval.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}