title: Community-acquired necrotizing soft tissue infections: a review of 122 cases presenting to a single emergency department over 12 years.
abstract: OBJECTIVE
  To characterize the Emergency Department (ED) presentation of necrotizing soft tissue infections (NSTI) and identify severity markers.
  
  
  METHODS
  Retrospective chart review of pathologically diagnosed NSTIs presenting to an urban ED from 1990-2001. Cases were identified from a surgical database, ICD-9 search and prospectively. Five Emergency Physicians (EPs) abstracted data using a standardized form. Severe NSTI was defined by any of the following: death, amputation, intensive care unit (ICU) stay >24 h, >300 cm(2) debrided. Severe and non-severe cases were compared using chi-square, Fisher's exact, and multivariate logistic regression testing.
  
  
  RESULTS
  The 122 cases were characterized by: injection drug use, 80%; fever, 44%; systolic blood pressure (BP) <100 mm Hg, 21%; white blood cell count (WBC) >20 x 10(9)/L, 43%; median time to operation, 8.4 h; mortality, 16%. The managing EP suspected NSTI in 59%. A systolic BP <100 mm Hg, BUN >18 mg/dL, radiographic soft tissue gas, admission to a non-surgical service and clostridial species were independently associated with severe NSTI.
  
  
  CONCLUSIONS
  Pathologically defined NSTIs have a wide spectrum of ED presentations and early diagnosis remains difficult.
authors.affiliation: Department of Emergency Medicine, Alameda County Medical Center - Highland Hospital, Oakland, California, USA.
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Frazee
authors.forename: Christopher
authors.initials: C
authors.lastname: Fee
authors.forename: Jeremy
authors.initials: J
authors.lastname: Lynn
authors.forename: Ralph
authors.initials: R
authors.lastname: Wang
authors.forename: Alan
authors.initials: A
authors.lastname: Bostrom
authors.forename: Cherie
authors.initials: C
authors.lastname: Hargis
authors.forename: Paul
authors.initials: P
authors.lastname: Moore
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D003422:Critical Care; D003646:Debridement; D004636:Emergency Service, Hospital; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D005260:Female; D006760:Hospitalization; D006786:Hospitals, Urban / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D015819:Substance Abuse, Intravenous / Q000150:complications