Early detecting cervical necrotizing fasciitis from deep neck infections: a study of 550 patients

Sideris, Giorgos; Sapountzi, Marilia; Malamas, Vangelis; Papadimitriou, Nikolaos; Maragkoudakis, Pavlos; Delides, Alexander

doi:10.1007/s00405-021-06653-4

Cited by 12 publications

(15 citation statements)

References 18 publications

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“…We calculated the diagnostic accuracy (i.e., diagnostic odds ratio [DOR]) and created a summary receiver operating characteristic (SROC) curve to calculate the area under the curve (AUC). 3,5,9,14,15,[18][19][20][21] The DORs were calculated as (true positives Â true negatives)/(false positives Â false negatives), with 95% confidence intervals (CIs) using a random effect model taking into account both intrastudy and interstudy variations. DORs range from 0 to infinity, with high values indicating better diagnostic performance, and a value of 1 indicating that the presence of disease cannot be inferred.…”

Section: Data Extraction and Risk Of Bias Assessmentmentioning

confidence: 99%

“…2,4 The pathogenesis of CNF occurs due to the infection of subcutaneous tissue along the fascia planes, resulting in venous thrombosis, abscess formation via inflammatory cell infiltration, movement to deep cervical spaces, and endarteritis obliterans. 5 Although the mortality rate of CNF itself is known to be 7-20% and the CNF can quickly propagate to mediastinum through fascial planes, the mortality rate rises to 31 to 41% when descending necrotizing mediastinitis occurs. 6,7 Moreover, with descending necrotizing mediastinitis, the sepsis incidence rate rises to 22% (7% if not), and if CNF, descending necrotizing mediastinitis, and sepsis occurs, the mortality rate reaches 64%.…”

Section: Introductionmentioning

confidence: 99%

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Application of the laboratory risk indicator for necrotizing fasciitis score to the head and neck: a systematic review and meta‐analysis

Kim

Hwang

2022

ANZ Journal of Surgery

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Background Recent studies have attempted to verify the predictive capability of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) for cervical necrotizing fasciitis (CNF). Methods The two authors independently reviewed six databases (PubMed, Cochrane, Embase, Web of Science, SCOPUS and Google Scholar databases were searched). Seven cohort studies were included in the analysis. Sensitivity and specificity were determined by extracting items from binary classification from each paper. The diagnostic accuracy of the included studies was evaluated using QUADAS ver. 2. Results The diagnostic odds ratio (OR) of LRINEC for CNF with the cutoff value of 6 was 13.9952 (95% CI, 3.8537; 50.8255, I2 = 76.7%). The area under the SROC curve was 0.842, suggesting acceptable diagnostic accuracy. The correlation between sensitivity and false positive rate was 0.055, indicating that it was not heterogeneous. The sensitivity, specificity, and negative predictive values were 0.7503 ([0.4637; 0.9126], I2 = 79.1%), 0.8455 ([0.7084; 0.9250], I2 = 96.0%) and 0.9829 ([0.9089; 0.9970], I2 = 93.7%), respectively. In the comparison of subgroups according to a LRINEC score (6–8, and), the cutoff value of 6 showed moderate sensitivity (75%) and high specificity (85%) and greater diagnostic power than other cutoff values. Conclusions LRINEC is a useful adjunctive tool for predicting CNF in patients with a soft tissue infection. In addition, a more accurate diagnosis is possible by using the LRINEC score with a cutoff value of 6.

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Section: Data Extraction and Risk Of Bias Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Application of the laboratory risk indicator for necrotizing fasciitis score to the head and neck: a systematic review and meta‐analysis

Kim

Hwang

2022

ANZ Journal of Surgery

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“…As both DNI and CNF can lead to life-threatening emergencies with potential airway compromise, early diagnosis is essential. DNI can be diagnosed by flexible fiberoscopy and CT, while there is no single gold standard for diagnosis of CNF [ 18 ]. Some groups consider CNF a surgical diagnosis confirmed by findings such as the presence of grayish necrotic fascia and the presence of foul-smelling pus [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…A high blood sugar level is associated with complications from multiple spaces of DNI, and Zheng et al [ 33 ] reported that >50% of DM patients in their study population had complications, which was significantly higher than the rate for the non-DM group. Sideris et al reported that CRP and blood sugar levels are highly correlated, and they considered the blood sugar level to be one of the most important clinical variables [ 18 ]. Due to the increased incidence of high blood sugar observed in patients with concurrent CNF and DNI, we suggest that the blood sugar level should be monitored initially and controlled after admission.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were initially treated with empirical, broad-spectrum, intravenous antibiotics, which were then narrowed according to the results of wound culture. The pathogenesis of CNF begins with the entry of organisms or spores into the soft tissues, and then deeper tissues become infected, larger venules and arterioles are occluded, and necrosis affects all tissue layers [ 18 ]. Infections of the second and third molars of the mandible are the most frequent etiologies of odontogenic CNF [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

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Factors Affecting Patients with Concurrent Deep Neck Infection and Cervical Necrotizing Fasciitis

et al. 2022

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Deep neck infection (DNI) is a severe disease of the deep neck spaces, which has the potential for airway obstruction. Cervical necrotizing fasciitis (CNF) is a fatal infection of the diffuse soft tissues and fascia with a high mortality rate. This study investigated risk factors in patients with concurrent DNI and CNF. A total of 556 patients with DNI were included in this study between August 2016 and December 2021. Among these patients, 31 had concurrent DNI and CNF. The relevant clinical variables were assessed. In univariate analysis, age (> 60 years, odds ratio (OR) = 2.491, p = 0.014), C-reactive protein (CRP, OR = 1.007, p < 0.001), blood sugar (OR = 1.007, p < 0.001), and diabetes mellitus (DM, OR = 4.017, p < 0.001) were significant risk factors for concurrent DNI and CNF. In multivariate analysis, CRP (OR = 1.006, p < 0.001) and blood sugar (OR = 1.006, p = 0.002) were independent risk factors in patients with concurrent DNI and CNF. There were significant differences in the length of hospital stay and therapeutic management (intubation, tracheostomy, incision and drainage) between DNI patients with and without CNF (all p < 0.05). While there were no differences in pathogens between the DNI alone and concurrent DNI and CNF groups (all p > 0.05), the rate of specific pathogen non-growth from blood cultures was 16.95% (89/525) in the DNI alone group, in contrast to 0% (0/31) in the concurrent DNI and CNF group (p = 0.008). Higher CRP and blood sugar levels were independent risk factors for the concurrence of DNI and CNF. With regard to prognosis, there were significant differences in the length of hospital stay and therapeutic management between the groups with and without CNF. While there were no significant differences in pathogens (all p > 0.05), no cases in the concurrent DNI and CNF group showed specific pathogen non-growth, in contrast to 89/525 patients in the group with DNI alone.

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C-reactive protein and neutrophil-to-lymphocyte ratio as key inflammatory indicators in the diagnosis of cervical necrotizing fasciitis

Qiu,

Wang,

ShangGuan

et al. 2024

Acta Oto-Laryngologica

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Early detecting cervical necrotizing fasciitis from deep neck infections: a study of 550 patients

Cited by 12 publications

References 18 publications

Application of the laboratory risk indicator for necrotizing fasciitis score to the head and neck: a systematic review and meta‐analysis

Application of the laboratory risk indicator for necrotizing fasciitis score to the head and neck: a systematic review and meta‐analysis

Factors Affecting Patients with Concurrent Deep Neck Infection and Cervical Necrotizing Fasciitis

C-reactive protein and neutrophil-to-lymphocyte ratio as key inflammatory indicators in the diagnosis of cervical necrotizing fasciitis

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