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Are we getting necrotizing soft tissue infections right? A 10‐year review
Author(s) -
Proud David,
Bruscino Raiola Frank,
Holden Dane,
Paul Eldho,
Capstick Robert,
Khoo Amy
Publication year - 2014
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12412
Subject(s) - medicine , fasciitis , debridement (dental) , referral , mortality rate , retrospective cohort study , surgery , intensive care unit , presentation (obstetrics) , abia , emergency medicine , general surgery , intensive care medicine , family medicine , agroforestry , palm oil , biology
Background The A lfred H ospital is a referral centre for necrotizing soft tissue infections ( NSTI s) in the state of V ictoria and receives around 20 such patients each year. We sought to compare our practice and outcomes against published data, and to examine management at referring hospitals to determine whether adjustments to current practices are required. Methods A retrospective chart review of patients admitted to the A lfred H ospital between 1 J anuary 2001 and 31 D ecember 2010 with a diagnosis of necrotizing fasciitis was conducted. Demographic, etiologic, treatment and outcome data were collected and analysed. Results Two hundred and nineteen patients were identified with a mean age of 54.76 years and a preponderance of men (63.47%). The overall mortality rate for the patient group was 15.98%. More than 80% of patients were transferred from another facility. Nearly 40% of patients did not undergo surgical debridement within 24 h of presentation to a hospital and 30.6% were not debrided prior to transfer. Patients underwent a median of three procedures at the A lfred H ospital and the majority of patients required admission to the intensive care unit (68.95%). Conclusion NSTI s remain a surgical emergency with high rates of mortality and resource requirements. The mortality rate at our institution compares well with other published series. Many patients experienced delays before undergoing debridement and in many cases were transferred without debridement. The trend towards transferring NSTI patients to centres accustomed to treating burns and major trauma seems logical, but should not delay life‐saving surgical debridement. Timing of transfer does not seem to affect mortality.