Publication: Necrotizing Soft Tissue Infection: Time is Crucial, and the Admitting Service Matters
Issued Date
2020-12-01
Resource Type
ISSN
15578674
10962964
10962964
Other identifier(s)
2-s2.0-85097113109
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
Surgical Infections. Vol.21, No.10 (2020), 828-833
Suggested Citation
Napaporn Kongkaewpaisan, John Hwabejire, Jae Moo Lee, Natawat Narueponjirakul, Karien Meier, April Mendoza, Noelle Saillant, Martin Rosenthal, David King, Peter Fagenholz, George Velmahos, Haytham M.A. Kaafarani Necrotizing Soft Tissue Infection: Time is Crucial, and the Admitting Service Matters. Surgical Infections. Vol.21, No.10 (2020), 828-833. doi:10.1089/sur.2019.262 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/60533
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
Necrotizing Soft Tissue Infection: Time is Crucial, and the Admitting Service Matters
Other Contributor(s)
Abstract
© Copyright 2020, Mary Ann Liebert, Inc. Background: Early diagnosis and prompt debridement of necrotizing soft tissue infection (NSTI) improves the outcome. We sought to determine whether failure to admit NSTI patients to acute care surgery (ACS) departments delays treatment and increases the mortality rate. Methods: Patients with NSTI were identified using the 2007-2018 institutional emergency surgery database at a tertiary care hospital. The diagnosis was confirmed by the operative/pathology reports. Patients who developed NSTI during hospitalization or underwent initial debridement at an outside hospital were excluded. Patients admitted to a non-ACS service (e.g., medicine, gynecology) were compared with those admitted to the ACS service with respect to co-morbidities, clinical presentation, time to surgery, and mortality rate. Multi-variable linear and logistic analyses were performed to determine whether admission to a non-ACS service predicts a delay in surgery or an increase in the mortality rate. Results: Of 132 patients, 91 met the inclusion criteria. The mean age was 53 years; 56% were male. Twenty patients (22%) were admitted to a non-ACS service, two thirds of them with an initial misdiagnosis (e.g., cellulitis). The demographics, co-morbidities, and clinical presentation were similar in the two groups except that the non-ACS group more often had human immunodeficiency virus infection (15.0% versus 2.8%; p = 0.04) and less often presented with erythema (70% versus 94.4%; p = 0.01). The median time to incision in non-ACS patients was significantly longer (24.8 versus 3.9 hours; p < 0.001). The mortality rates were 20.0% for the non-ACS group and 7.0% for the ACS group (p = 0.086). Multi-variable analyses revealed that absence of erythema is independently associated with a non-ACS admission (odds ratio [OR] 5.9; 95% confidence interval [CI] 1.3-25.6; p = 0.02), and non-ACS admissions correlated independently with delayed surgery (OR 35.20; 95% CI 3.86-321.20; p = 0.002). Conclusions: Admission of patients with NSTI to a non-ACS service often occurs because of initial misdiagnosis, especially in the absence of skin erythema; correlates with significantly delayed surgery; and might lead to more deaths.