Objective criteria may assist in distinguishing necrotizing fasciitis from nonnecrotizing soft tissue infection.
BACKGROUND
Optimal treatment of necrotizing fasciitis (NF) requires rapid diagnosis. The purpose of the study was to identify objective admission measurements that help differentiate NF from nonnecrotizing (non-NF) infection and, among NF patients, to identify admission factors that predict mortality.


METHODS
Twenty-one NF cases were paired with matched non-NF controls. Statistical comparison of admission vital signs, laboratory values, and radiographic studies was performed.


RESULTS
On multivariate analysis, admission white blood cell count (WBC) >14 x 10(9)/L, serum sodium <135 mmol/L, and blood urea nitrogen (BUN) >15 mg/dL separated NF from non-NF patients. Mortality for NF patients was predicted by admission WBC >30 x 10(9)/L. Mortality was also significantly increased for patients transferred from an outside institution prior to definitive therapy.


CONCLUSIONS
Objective admission criteria (elevated WBC and BUN and decreased serum sodium) can assist in distinguishing NF from non-NF infections. The best objective predictor of mortality in NF patients is marked elevation of admission WBC.
Wall
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DB
Department of Surgery, Harbor-University of California Los Angeles Medical Center, Torrance 90509, USA.
de Virgilio
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C
Black
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Klein
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SR
D000328:Adult; D001806:Blood Urea Nitrogen; D016022:Case-Control Studies; D002481:Cellulitis / Q000097:blood / Q000175:diagnosis; D003937:Diagnosis, Differential; D019115:Fasciitis, Necrotizing / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D010360:Patient Transfer; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012964:Sodium / Q000097:blood; D018461:Soft Tissue Infections / Q000097:blood / Q000175:diagnosis*; D015819:Substance Abuse, Intravenous
D012964:Sodium