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
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.
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
- ↑ 1.0 1.1 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.