Some researchers and clinicians have advocated the use of scoring systems, such as the Fournier Gangrene Severity Index (FGSI), as a prognostic tool for patient mortality once the disease is confirmed.4 Although its academic merits are without question, the clinical utility of FGSI in early management is debatable.6 FGSI is meant to predict a patient’s likely mortality risk associated with the disease, not to guide clinical decision-making. FGSI analyzes temperature, heart rate, respiratory rate, white blood cell count, hematocrit, serum sodium, serum creatinine, and bicarbonate levels to create a value to predict patient mortality.15 A score from the FGSI >9 is associated with high likelihood of mortality, and a score <9 is associated with a greater likelihood of survival.4,9,13,15
Although rare, FG may be associated with significant risk for morbidity and mortality especially if recognition and treatment are delayed, which is common due to ambiguous history and physical examination findings. Although risks can be reduced significantly with preventive health management of key comorbid conditions, namely those associated with immunodeficiency, disease cannot always be prevented. If FG develops despite these preventive efforts, prompt identification and management, including early antibiotic administration and surgical intervention, are the foundations of mortality reduction and require a high index of suspicion on the part of the examiner.
Mara Kohls, MPAS, PA-C, is a physician assistant with Qualified Emergency Specialists, Inc. and the Department of Emergency Medicine of the University of Cincinnati in Cincinnati, Ohio. Christopher M. Howell, DSc, MSc, MPAS, PA-C, MBA, FAAPA, is an associate professor at Kettering College in Kettering, Ohio, and practices in Indiana and Ohio in addiction and emergency medicine.
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