Assessment of Functional Limitation After Necrotizing Soft Tissue Infection

Pham, Tam N.; Moore, Merilyn L.; Costa, B. A.; Cuschieri, Joseph; Klein, Matthew B.

doi:10.1097/bcr.0b013e318198a241

Cited by 51 publications

(39 citation statements)

References 12 publications

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“…[24][25][26][27] All the patients in NSTI group required debridement under general anesthesia as compared to only 15% Non NSTI patients and mean number of major debridement's required in NSTI group (3.5 vs 1.5) were more and statistically significant similar to other studies. 28,29 Prolonged hospital stay has been associated with NSTI due to repeated major debridement's and systemic involvement compared to Non NSTI patients similar to present study, 18.6 days. 30 Therefore, early diagnosis and debridement is required for adequate management of NSTI to avoid high morbidity and prolonged hospital stay.…”

supporting

confidence: 77%

Clinicopathological profile and management outcome of skin and soft tissue infections at tertiary care centre of sub Himalayan region

Nautiyal¹,

Agarwal²,

Sachdev³

et al. 2018

Int Surg J

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INTRODUCTIONHippocrates first described NSTI in the 5 th century BC. He described it as a complication of acute streptococcal infection, writing "many were attacked by the erysipelas all over the body when the exciting cause was a trivial accident flesh, sinews, and bones fell away in large quantities". There were many deaths.1 But first Englishlanguage descriptions of NSTIs were by the British surgeon Leonard Gillespie and British physicians Gilbert Blaine and Thomas Trotter in the late 18 th century. The disease was known as phagedaenic ulcer, gangrenous, gangrenous ulcer, malignant ulcer, putrid ulcer, or hospital gangrene. 2 ABSTRACTBackground: Many times, it is difficult to differentiate between Necrotizing soft tissue infections (NSTI) and Non NSTI based on symptoms, signs and investigations. Only early diagnosis and debridement can prevent high morbidity associated with it. Methods: This prospective observational, study was conducted in the department of General Surgery, over a period of 1 year on consecutive 100 admitted patients. Clinical signs, symptoms and vital parameters of NSTI group and Non NSTI group were compared. Biochemical investigations, systemic involvement and treatment received was also evaluated. Chi-square analysis was performed to compare categorical variables. Results: A 77.8% of the NSTI and 54.7% of the Non NSTI infections occurred in males. Significant difference was found in mean age in patients with NSTI (50.9±13.1) and Non NSTI (41.1±15). Type II DM (38.9%) and hypertension (8.3%) were more commonly associated with NSTI patients. Mean pulse rate, respiratory rate and body temperature were significantly more in NSTI group. Patients with NSTI had significantly less hemoglobin and increased creatinine as compared to Non NSTI group. In NSTI group, 83% of patients had necrotizing fasciitis along with myonecrosis followed by Fournier's gangrene (13.8%). Among Non NSTI group perianal abscess and subcutaneous abscess constituted 45.31% of patients. Methicillin sensitive staphylococcus aureus was found in 43.8% and 38.9% of Non NSTI and NSTI groups respectively. Conclusions: Classical symptoms and signs of NSTI are not reliable and often investigations also fail to differentiate between NSTI and Non NSTI. Type 2 diabetes mellitus patients are more prone to it. High level of clinical suspicion is required for early diagnosis. Timely and adequate debridement of NSTI is necessary to decrease morbidity and mortality.

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supporting

confidence: 77%

Clinicopathological profile and management outcome of skin and soft tissue infections at tertiary care centre of sub Himalayan region

Nautiyal¹,

Agarwal²,

Sachdev³

et al. 2018

Int Surg J

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“…Because of similarities between survivors of severe burns and survivors of NSTI, Pham and colleagues 81 adapted the impairment rating scale, which had been validated among survivors of burn injuries, to quantify the physical limitations of survivors of NSTI. They found that 30% of survivors had mild to severe functional limitation at time of discharge.…”

Section: In-hospital and Long-term Outcomesmentioning

confidence: 99%

Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes

Hakkarainen¹,

Kopari²,

Pham³

et al. 2014

Current Problems in Surgery

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333

356

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“…7 Another study found that a high percentage of NSTI survivors have moderately to severely impaired functional status at time of discharge. 8 While this would suggest risk of long-term poor functional status, there is no long term data available to support this assertion.…”

Section: Introductionmentioning

confidence: 99%

Moving beyond survival as a measure of success: understanding the patient experience of necrotizing soft-tissue infections

Hakkarainen

Ikebata

Bulger

et al. 2014

Journal of Surgical Research

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Background Necrotizing Soft Tissue Infections (NSTIs) represent a devastating spectrum of disease with high case-mortality and resource intensive care. Treatment consists of wide surgical debridement and often prolonged periods of ICU care. Major complications are common. The severity of the disease and the aggressive treatment requirements put survivors at risk for significant long-term sequelae related to the trauma of both disease and treatment. Information about the post-discharge impact of NSTIs on survivors is extremely limited. Qualitative approaches are typically used to explore new phenomena and to capture individuals' thoughts, feelings, or intepretations of meaning and process. Therefore, qualitative methods are ideally suited for hypothesis generation to guide future quantitative study and ensure measured outcomes are patient-centered. Materials and Methods Semi-structured interviews were conducted with survivors of NSTIs from a single regional referral center. Stratified, purposive sampling was used to select interview candidates based on severity of illness. Descriptive thematic analysis was performed to identify major themes described by the patients. Results Interviews with 18 survivors identified 3 primary domains of experience: 1) individual factors, 2) relational factors, and 3) societal factors. These domains were split into two categories: factors effecting the disease process and recovery, and factors that were outcomes of the disease process. Each category yielded between one and seven themes. Themes identified included physical, psychological, relationship, and employment aspects. Conclusions Patient's reported quality of life was significantly affected by their disease and recovery. The results demonstrate that many outcomes of importance for patients are not easily assessed by traditional measures of outcomes. This work illustrates the multi-dimensional nature of recovery from critical illness, and show that it represents a massive transition period in the lives of survivors that affects the patient, their family, and the patient's ability to interact with society. Interviews with survivors ensure that the patient voice is heard prior to developing tools to assess long-term outcomes.

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Assessment of Functional Limitation After Necrotizing Soft Tissue Infection

Cited by 51 publications

References 12 publications

Clinicopathological profile and management outcome of skin and soft tissue infections at tertiary care centre of sub Himalayan region

Clinicopathological profile and management outcome of skin and soft tissue infections at tertiary care centre of sub Himalayan region

Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes

Moving beyond survival as a measure of success: understanding the patient experience of necrotizing soft-tissue infections

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