title: Are we getting necrotizing soft tissue infections right? A 10-year review.
abstract: 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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Plastic, Hand and Maxillofacial Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Proud
authors.forename: Frank
authors.initials: F
authors.lastname: Bruscino Raiola
authors.forename: Dane
authors.initials: D
authors.lastname: Holden
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.forename: Robert
authors.initials: R
authors.lastname: Capstick
authors.forename: Amy
authors.initials: A
authors.lastname: Khoo
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003646:Debridement / Q000379:methods; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; 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
chemical_list: D000900:Anti-Bacterial Agents
keywords: Fournier's gangrene; necrotizing fasciitis