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Plenary Paper
Can necrotizing soft tissue infection be reliably diagnosed in the emergency department?
  1. Sharon M Henry1,
  2. Kimberly A Davis2,
  3. Jonathan J Morrison1,
  4. Thomas M Scalea1
  1. 1 R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
  2. 2 Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Jonathan J Morrison, R Adams Cowley Shock Trauma Center, Baltimore, MD 21201, USA; jonathan.morrison{at}umm.edu

Abstract

Necrotizing soft tissue infections (NSTIs) are associated with a high mortality and require prompt recognition and treatment, consisting of aggressive surgical debridement and critical care support. Diagnosis is a key step, which is generally made in the operating room (OR), but the decision to debride requires guidance. This is frequently made on clinical grounds, but NSTI can be occult in presentation and several other infective processes can mimic NSTI. It is unknown whether the various scoring systems described in the literature can enable clinicians to reliably diagnose NSTI in the emergency department, rather than the OR. The topic was debated at the 36thAnnual Point/Counterpoint Acute Care Surgery Conference and the following article summarizes the discussants points of view along with a summary of the evidence.

Level of evidence Level III.

  • necrotizing fasciitis
  • necrotizing: fasciitis
  • emergency department assessment

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/tsaco-2017-000157

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    Footnotes

    • Contributors SMH, KAD: debater, manuscript editing. JJM: manuscript writing. TMS: conception, manuscript editing.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.