Scoring suspicion, timing debridement, and refusing routine adjuncts

(A) A score of 7 crosses the published 6-point cutoff with 92.0% positive and 96.0% negative predictive value in its own cohorts — so evaluate carefully for necrotising fasciitis, but later pooling drops sensitivity to 43.2 to 80% and the score fails the immunocompromised, meaning bedside assessment rules and doubt means imaging plus exploration.^[6][7] Image without pausing the knife: fascial MRI signal is sensitive at 86.4% yet modestly specific, CT gas is specific at 93.2% yet half-blind — and with only a minority diagnosed at admission, exploration on suspicion is the plan.^[8][10][5]

(B) Debride as soon as possible, ideally within 6 hours with re-looks every 12 to 24 hours — yet counsel the equipoise honestly: delay past 24 hours alone predicted death at RR 9.4, while 6-hour surgery showed no survival edge among day-one operated patients.^[5][10][13] Do not let transfer insert the delay: referred patients die at 15.5% against 8.7% with doubled adjusted odds — so move fast or operate where she lies.^[15]

(C) Start broad-spectrum cover at once, tailor on tissue cultures, and continue to complete debridement with improvement — then stop the adjuncts: 100 randomised patients showed no IVIG functional benefit at six months, and routine hyperbaric oxygen lacks support — so neither enters the standard prescription.^[5][17]