Dermal Infection Severity Score - Medical Algorithm

Description

Wilson et al developed a score for evaluating patients with complicated infections of skin and soft tissue due to Gram-positive bacteria. This can help identify patients who may require more aggressive management. The authors are from the University of California at Irvine, the University of Cincinnati, and Pharmacia Corporation (makers of linezolid).

Patient selection: complicated infection of skin and soft tissue (deep and serious) due to a Gram-positive bacteria (Staphylococcus, Streptococcus, Enterococcus)

Parameters:

(1) age in years

(2) comorbid diseases (9)

(3) respiratory rate

(4) systolic blood pressure

(5) body temperature in °C

(6) heart rate

(7) BUN

(8) serum sodium

(9) blood glucose

(10) hematocrit

(11) WBC count

(12) percent bands in the peripheral blood smear

(13) bacteremia (positive blood cultures)

(14) deep tissue involvement

(15) diameter of skin lesion

(16) surgical site infection

Parameter	Finding	Points
age of the patient in years
cancer	absent	0
	present	30
cardiac disease	absent	0
	present	10
diabetes mellitus	absent	0
	present	10
liver disease	absent	0
	present	20
immunologic disorder	absent	0
	present	30
renal disease	absent	0
	present	10
lung disease	absent	0
	present	30
organ transplantation	absent	0
	present	30
vascular disease	absent	0
	present	10
respiratory rate	<= 30 breaths per minute	0
	> 30 breaths per minute	20
systolic blood pressure	>= 90 mm Hg	0
	< 90 mm Hg	20
body temperature	< 35°C	15
	35 - 40°C	0
	> 40°C	15
heart rate	<= 125 beats per minute	0
	> 125 beats per minute	10
BUN	<= 30 mg/dL	0
	> 30 mg/dL	20
serum sodium	>= 130 mmol/L	0
	< 130 mmol/L	20
glucose	<= 250 mg/dL	0
	> 250 mg/dL	10
hematocrit	>= 30 percent	0
	< 30 percent	10
WBC count	< 4,500 per µL	10
	4,500 to 10,000 per µL	0
	> 10,000 per µL	10
percent bands	<= 15%	0
	> 15% (left shift)	10
bacteremia	absent	0
	present	20
deep tissue involvement	absent	0
	present	10
size of skin lesion	<= 150 square cm	0
	> 150 square cm	10
surgical site infection	absent	0
	present	10

where:

• A circular skin lesion 150 square cm corresponds to a diameter of 13.8 cm.

total score =

= SUM(points for all of the parameters)

Interpretation:

• minimum score: 0 (or age of the patient)

• maximum score: 475

• The higher the score the more severe the infection.

• The cure rate is lower for Risk Group IV, the presence of at least 1 comorbid condition, elevated BUN, hyponatremia, anemia, large lesions, and surgical site infections.

Total Score	Risk Group
<= 64	I
65 to 82	II
83 to 100	III
>= 101	IV

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Description

Specialty

Objective

ICD-10

Disease Severity Score of Wilson et al for Complicated Infections of Skin and Soft Tissue

Purpose: To evaluate a patient with a complicated skin and soft tissue bacterial infection using the score of Wilson et al.

Description

Specialty

Objective

ICD-10