A 10-Year Review of Necrotizing Fasciitis in the Pediatric Population: Delays to Diagnosis and Management.
OBJECTIVE
To assess the promptness and appropriateness of management in pediatric cases of necrotizing fasciitis (NF).


METHODS
A retrospective chart review examined cases of pediatric NF treated at a pediatric tertiary care center over a 10-year period.


RESULTS
Twelve patients were identified over the 10-year period. The median (25th to 75th centile) times to appropriate antibiotic administration, infectious disease consults, surgical consults and debridement surgeries were 2.6 (2.1-3.2), 7.7 (3.4-24.4), 4.6 (1.7-21.0), and 22.1 (10.3-28.4) hours following assessment at triage. The initial antibiotic(s) administered covered the causative organism in 9 of 12 cases. The median (25th to 75th centile) length of hospital stay was 21 (14.0-35.5) days.


CONCLUSIONS
The large variability in the care of these patients speaks to the range of their presenting symptomatology. The lack of a standardized approach to the pediatric patient with suspected NF results in delays in management and suboptimal antibiotic choice.
1 University of Toronto, Toronto, Ontario, Canada.
Heather
H
VanderMeulen
2 McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
Jeffrey M
JM
Pernica
2 McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
Madan
M
Roy
2 McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
April J
AJ
Kam
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000706:statistics & numerical data*; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009864:Ontario; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage
D000900:Anti-Bacterial Agents
emergency medicine; necrotizing fasciitis; pediatric; quality improvement; soft tissue infection