Early diagnosis of necrotizing fasciitis

Goh, Terence; Goh, Lee Gan; Ang, C. H.; Wong, Chin‐Ho

doi:10.1002/bjs.9371

Cited by 352 publications

(376 citation statements)

References 24 publications

(58 reference statements)

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“…No RCT could be found that compared the usefulness of achieving early source control in sepsis caused by necrotizing soft tissue infection, although there exist guidelines57, 58 and a review59 on this subject. Although early diagnosis and administration of broad‐spectrum antimicrobials can be effective in improving the prognosis of patients with necrotizing soft tissue infection, when treating patients with organ dysfunction arising from necrotizing soft tissue infection, that is, patients with sepsis, surgical intervention including swift and aggressive drainage of infected lesions is recommended by two different guidelines 57, 58.…”

Section: Introductionmentioning

confidence: 99%

“…Although early diagnosis and administration of broad‐spectrum antimicrobials can be effective in improving the prognosis of patients with necrotizing soft tissue infection, when treating patients with organ dysfunction arising from necrotizing soft tissue infection, that is, patients with sepsis, surgical intervention including swift and aggressive drainage of infected lesions is recommended by two different guidelines 57, 58. A review study examining the timing of surgical procedures also suggests that initiating surgery within 24 h after diagnosis can improve the mortality rate by ~20% more than surgeries performed after this period 59. If clinical symptoms persist after surgery, practical guidelines57 recommend performing reoperation while continuing antimicrobial administration for an additional 24–36 h. Based on the above, it is believed that surgery should be initiated at the earliest opportunity in cases of sepsis arising from necrotizing soft tissue infection.…”

Section: Introductionmentioning

confidence: 99%

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

View full text Add to dashboard Cite

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“…DM is often reported in NF cases, with a mean of 44.5% 5 and it is considered as a predisposal disease to NF also because of the high rate of cutaneous infections or ulcers. In the same study it is showed a strong correlation between DM and limb amputation, but not with death.…”

Section: Discussionmentioning

confidence: 99%

The relevance of a fast and early diagnosis of necrotizing fasciitis in the Emergency Department: a case report

Gregorio¹,

Villa²

2016

Ital J Med

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We report a case of necrotizing fasciitis in an 84-year-old man affected by diabetes mellitus. The patient was admitted in the Emergency Department of our hospital because of an acute and strong left leg pain that began almost 8 h before admission. The left leg had an increased size and a movement limitation, with a hard hematoma in the left thigh with subcutaneous crepitus. The lesion became worse and larger rapidly, with a wide extension from the back to the popliteal fossa. An antimicrobial therapy was immediately started with morphine for pain. A surgical debridement was performed, but the patient died for multi-organ failure. Necrotizing fasciitis is a rare and mortal disease, the early diagnosis is a challenge for the Emergency Department where patients are admitted and assessed primarily.

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“…Although a conclusion may review the main points of the paper, do not replicate the abstract as the conclusion. A conclusion might elaborate on the importance of the work or suggest applications and extentions Even though early diagnosis and surgical intervention of NF can reduce mortality and morbidity including amputation rates, it is a major diagnostic challenge because, pathognomonic signs are absent in most of the cases [32]. But still a high index of suspicion will prompt any clinician to make early diagnosis based on clinical findings depending upon the stage of the disease at the time of presentation and [2,3,6,8,15,16].…”

Section: Discussionmentioning

confidence: 99%