Are we getting necrotizing soft tissue infections right? A 10-year review.
BACKGROUND
The Alfred Hospital is a referral centre for necrotizing soft tissue infections (NSTIs) in the state of Victoria 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 Alfred Hospital between 1 January 2001 and 31 December 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 Alfred Hospital and the majority of patients required admission to the intensive care unit (68.95%).


CONCLUSION
NSTIs 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.
['Proud|David|D|', 'Bruscino Raiola|Frank|F|', 'Holden|Dane|D|', 'Paul|Eldho|E|', 'Capstick|Robert|R|', 'Khoo|Amy|A|']
D000328:Adult D000368:Aged D000900:Anti-Bacterial Agents D015331:Cohort Studies D003131:Combined Modality Therapy D016001:Confidence Intervals D003646:Debridement D019115:Fasciitis, Necrotizing D005260:Female D005500:Follow-Up Studies D017052:Hospital Mortality D006785:Hospitals, University D006801:Humans D006931:Hyperbaric Oxygenation D007902:Length of Stay D016015:Logistic Models D008297:Male D008875:Middle Aged D017063:Outcome Assessment, Health Care D012017:Referral and Consultation D012189:Retrospective Studies D018570:Risk Assessment D012720:Severity of Illness Index D015996:Survival Rate D016896:Treatment Outcome D014739:Victoria
necrotizing fasciitis Fournier's gangrene