title: Clinical and imaging factors associated with severe complications of cervical necrotizing fasciitis.
abstract: OBJECTIVE
  Cervical necrotizing fasciitis (CNF) is a severe and debilitating disease that requires intensive care unit (ICU) management and prompt surgical treatment to reduce morbidity and mortality. The aim of this study was to estimate the incidence and factors associated with severe complications of CNF.
  
  
  METHODS
  We reviewed the medical records of consecutive patients hospitalized in an ICU from 2007 to 2012. The data were collected retrospectively; initial cervical and thoracic computed tomography (CT) scans, performed on admission, were reviewed by an experienced and blinded radiologist to determine CNF complications.
  
  
  RESULTS
  A cohort of 160 patients admitted for CNF was included. The following complications of CNF were found: bilateral extension of CNF (28%), internal jugular vein thrombosis (21%), descending necrotic effusion (14%), mediastinitis (24%), and mortality (4%); 53% had at least one complication, and 48% had at least one cervical complication. On the basis of a univariate analysis, the significant independent factors are odynophagia, dyspnea, oral glucocorticoids intake before admission, and pharyngeal source. Oral nonsteroidal anti-inflammatory drug intake before admission does not have any impact. The initial CNF complications increased both the duration of mechanical ventilation and the length of stay in the ICU. On the basis of a multivariate analysis, the independent factors for severe complications are pharyngeal CNF and oral glucocorticoid intake before admission.
  
  
  CONCLUSIONS
  Our study demonstrated that an initial cervico-thoracic CT scan revealed a high incidence of cervical and mediastinal CNF complications that all needed immediate management. Those severe complications might be avoidable as they were associated, at least partially, with prehospital oral glucocorticoid intake.
authors.affiliation: Mobile Care Unit, Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, AP-HP, Inserm UMR-S 942, University Paris 7, 2 rue Ambroise Paré, 75010, Paris Cedex 10, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Nougué
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Le Maho
authors.forename: Mourad
authors.initials: M
authors.lastname: Boudiaf
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Blancal
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.forename: Mathieu
authors.initials: M
authors.lastname: Le Dorze
authors.forename: Fabrice
authors.initials: F
authors.lastname: Vallée
authors.forename: Benjamin
authors.initials: B
authors.lastname: Verillaud
authors.forename: Joaquim
authors.initials: J
authors.lastname: Mateo
authors.forename: Hakim
authors.initials: H
authors.lastname: Kechiche
authors.forename: Claudia
authors.initials: C
authors.lastname: Pignataro
authors.forename: Philippe
authors.initials: P
authors.lastname: Herman
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019115:Fasciitis, Necrotizing / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007601:Jugular Veins; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000209:etiology; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013256:Steroids / Q000009:adverse effects* / Q000627:therapeutic use; D013927:Thrombosis / Q000209:etiology; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D013256:Steroids