Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2017; 84(4):263-270 | DOI: 10.55095/achot2017/041

Časné indikátory související s mortalitou u pacientů s podezřením na nekrotizující fasciitisPůvodní práce

S.-M. CHOI, K.-B. LEE^*

Department of Orthopaedic Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea

PURPOSE OF THE STUDY:
There are little reports about criteria or predictors for evaluation of the severity of necrotizing fasciitis (NF) leading to death. The purpose of this study is to evaluate the risk factors to predict mortality through analysis of historical, clinical, laboratory and radiographic findings in the patients suspected NF in emergency room and assist surgeons in taking preventative measures or appropriate treatment to increase survival rates on the basis of the early predictor related mortality.

MATERIAL AND METHODS:
67 consecutive patients who received a fasciotomy under the impression of NF in emergency room were divided into two groups on the basis of the result of treatment; Death (D) and survival (S) groups which were compared as follows: demographics, cause of death, number of surgical procedures, surgical period, intensive care unit period, hospital period, causes of NF, underlying disease, infected site, duration from symptom appearance to surgical day, vital sign (blood pressure, pulse and respiration rates, fever, peripheral O2 saturation), wound appearance, physical examination, laboratory study (vein and artery blood), radiologic findings and microorganism cultivation (blood and infected site culture) were evaluated for analysis.

RESULTS:
The mortality rate was 21% (n = 14) and the survival rate was 79% (n = 53). Most common causes of death was septic shock (85%, n = 12). Mortality of patient with NF were increased with statistically significant difference when no open wound at involved site (p = 0.05), cold skin sensation compared to other site (p = 0.04), frank cutaneous gangrene with skin sloughing (p = 0.009), vascular insufficiency (p = 0.04) and motor dysfunction (motor grade < 3) (p = 0.01). Air formation along the fascial plane have statistically significantly difference (p = 0.004). Most involved sites in death group were proximal area such as hip and thigh (65%), in sequence knee (11%) and calf (24%). While distal portion of extremities such as calf (31%), ankle and foot (25%) or forearm (30%) and hand (54%) were more common in survival group. The ratio between single and multi-organisms in each group had no statistically significant difference: respectively 67% and 33% in survival and 58% and 42% in death group.

CONCLUSIONS:
Recognition of several risk factors (cold skin sensation, gangrene, vascular insufficiency, motor dysfunction, air formation, and proximal involvement) associated with toxicity and mortality could help surgeon to determine the necessity of further evaluation, proper selection of drug and operative timing, and those could improve the referral service in suspected cases of necrotizing fasciitis and avoid unnecessary delays in treatment.


Level of evidence: IV, retrospective cohort study.

Klíčová slova: necrotizing fascitis, emergency room, survival, predictors

Zveřejněno: 1. srpen 2017  Zobrazit citaci