Background Necrotising fasciitis (NF) is a life-threatening soft-tissue infection associated with high morbidity and mortality. The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score was developed to aid early diagnosis, but its association with clinical outcomes remains uncertain. Most existing data originate from tertiary referral centres. This study evaluated clinical outcome, LRINEC score performance, and surgical timing in NF cases managed in a district general hospital in the United Kingdom over a 10-year period. Methodology This retrospective cohort study followed STROBE guidelines and included 48 adult patients with surgically confirmed NF (clinical features, laboratory parameters, intraoperative findings, and/or histopathological confirmation) treated between January 2013 and December 2023. Variables collected included demographics, comorbidities, LRINEC scores, time to first debridement, number of surgical debridements, intensive care unit (ICU) admission, hospital length of stay, and in-hospital mortality. Statistical analysis included chi-square or Fisher’s exact tests, non-parametric comparisons (Kruskal-Wallis test, Mann-Whitney U test), and Spearman’s correlation analyses, with statistical significance set at p-values <0.05. Owing to sample size, analyses were exploratory and unadjusted; multivariable modelling was not performed. The study was registered and approved as a Clinical Audit by the Trust Clinical Audit Review Panel (reference: 7926). Individual consent was waived as anonymised retrospective audit data were used. Results The mean patient age was 62.2 years (SD = 12.1), with 56.2% male predominance (27/48). Lower limbs were affected in 83.3% (40/48) of cases. Mean LRINEC score was 7.9 ± 2.3, with 66.7% (32/48) classified as high-risk (≥8). Overall mortality was 27.1% (13/48), and 81% (39/48) required ICU admission. Mean hospital stay was 24.3 ± 18.6 days; patients required an average of 3.0 ± 1.4 surgical debridements. Group A Streptococcus was the most common pathogen (21/48, 43.8%). Higher LRINEC scores showed a positive correlation with the number of surgical debridements required (Spearman’s ρ = 0.32, p = 0.027) but not with mortality or ICU admission. Shorter time to surgery was associated with higher mortality (p = 0.031), which may reflect confounding by indication in this unadjusted analysis. Conclusions In district hospital settings, NF carries substantial morbidity and mortality despite aggressive management. In this cohort, higher LRINEC scores were associated with a greater number of surgical debridements but not with mortality. The inverse relationship between shorter time to surgery and mortality likely reflects confounding by indication, though this could not be confirmed in this unadjusted analysis. These exploratory findings suggest that LRINEC may have a role in anticipating operative demand, but larger prospective studies are needed to validate this observation.
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