The impact of COVID-19 on delayed presentations of necrotising fasciitis

Nguyen, Quoc Dung; Diab, Jason; Khaicy, David; Diab, Vanessa; Hopkins, Zachias; Foong, Lai Heng; Berney, Christophe R.

doi:10.1093/jscr/rjac015

Cited by 5 publications

(6 citation statements)

References 25 publications

(28 reference statements)

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“…This can be linked to the transformation of less urgent complaints into more serious conditions due to delayed presentation corroborated by multiple case reports. [17] [18] [19] Our previous studies have demonstrated instances of severe disease with delays in presenta-tions for pathologies such as necrotising fasciitis [20], due to fears of contracting COVID-19 at hospitals and/or clinics. This study provided insight into the mindset of the SWSLHD population at the time where all patients denied any reason for delay to ED with sound knowledge of personal protection and sufficient access to COVID-19 information.…”

Section: Discussionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on a Sydney Metropolitan Hospital Emergency Department

Scott-King¹,

Hodder²,

Thomas³

et al. 2022

OJEM

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Introduction: The impact of the COVID-19 has resulted in a decrease in presentations in emergency departments (ED). This has been influenced by societal restrictions, lockdowns and access to services. This study aims to observe the patterns in ED presentations for Bankstown-Lidcombe Hospital over the course of the initial COVID-19 pandemic wave. Methods: A retrospective review of all presentations to Bankstown-Lidcombe Hospital ED was conducted comparing monthly patient encounters from February-August for 2017-2020. Results: The total number of ED presentations was 42,225. There was a statistically significant reduction during 2020 of 9.8% between the study periods (1546 vs 1395, p = 0.014). The period of greatest reduction was seen in March-May, the strictest lockdown period for New South Wales. The admitting disciplines that showed a reduction in this time were colorectal (76.62%, p = 0.046), emergency (25.53%, p = 0.025), endocrine (31.82%, p = 0.026), orthopaedics (33.63%, p = 0.004), and vascular (35.71%, p = 0.017). The disciplines that showed an increase in presentations over the entire studied time were gynaecology (26.54%, p = 0.008), and psychiatry (17.46%, p = 0.011). Conclusion: There were significant reductions in total number of ED presentations. Notably, there were significant reductions across multiple admitting disciplines, as well as in a decrease in presentations for those in younger age groups.

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Section: Discussionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on a Sydney Metropolitan Hospital Emergency Department

Scott-King¹,

Hodder²,

Thomas³

et al. 2022

OJEM

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“…Globally, NF is associated with significant mortality and this is further increased when caused by atypical organisms such as S. marcescens [ 2 ]. A recent study by Nguyen et al showed that in Australia, patients with NF during the COVID-19 lockdown tended to present later and more critically ill, leading to a 50% mortality rate compared to 0% in their pre-COVID-19 cohort [ 8 ]. Of note, none of the patients in the study actually tested positive for COVID-19 (they were distinguished by study period only, i.e., pre- and during COVID-19).…”

Section: Discussionmentioning

confidence: 99%

“…While studies such as that by Nguyen et al suggest that the mortality rate of NF during COVID-19 was higher, this is likely due to further progression of pathology due to delayed presentation (mean of 4.1 days) as demonstrated by more highly deranged biochemical results (i.e., doubling of creatinine and lactate, and tripling of urea) [ 8 ]. In turn, the LRINEC score in these patients was an average of 5.9, which equates to an intermediate (50-75%) risk of developing NF.…”

Section: Discussionmentioning

confidence: 99%

Lower Limb Serratia marcescens Necrotizing Fasciitis Complicated by Nosocomial COVID-19

Aftab¹,

Tay²,

Sauvé³

et al. 2023

Cureus

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Serratia marcescens represents an unusual yet potentially deadly cause of lower limb necrotizing fasciitis (NF). Compounding the already high mortality of NF, S. marcescens infections are usually associated with worse outcomes (i.e., amputation). Here we present the case of a 56-year-old immunocompromised man due to lupus nephritis who developed lower limb NF secondary to S. marcescens followed by nosocomial coronavirus disease 2019 (COVID-19) pneumonitis. Successful limb salvage was achieved through a multidisciplinary team approach from various specialties including plastic surgery, orthopedic surgery, anesthesiology, intensive care, respiratory medicine, and nephrology. At 11 months' follow-up, the patient was largely independent with activities of daily living and was able to ambulate. Unfortunately, he suffered a myocardial infarction at 19 months post-operatively and passed away. A review of the literature revealed only a handful of cases of lower limb NF due to S. marcescens and none with subsequent COVID-19. Therefore, this is the first report of such a case which should help with the clinical management of such cases going forward, especially with COVID-19 now becoming endemic in our communities and contributing to delayed presentations and increased mortality in NF.

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“…Our previous work identified that those with necrotising fasciitis in the COVID-19 group had a significantly longer mean onset of symptoms till hospital presentation of 4.1 days, longer mean operative time, more likely to be admitted to ICU and not survive compared to their counterparts. 15 A Melbourne based study who experienced different restrictions compared to Sydney reported those who had operations after-hours in the COVID-19 period were more likely to present with severe cholecystitis. 16 An Israeli study who had similar experiences with lockdowns, but at the time overall better vaccination rates compared to Australia reported significant delays of presentation from onset of symptoms resulting in worse biochemical and clinical parameters compared to the control cohort.…”

Section: Discussionmentioning

confidence: 99%

The patterns and changes of general surgical presentations during the first wave COVID-19 pandemic at a metropolitan Sydney hospital

et al. 2022

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Background: The impact of SARS-COV-2 virus (COVID-19) has been well documented in international settings with a reduction in overall emergency presentations both influenced by social distancing and lockdowns. This study focuses on several common acute general surgical pathologies exploring differences in presentations and clinical outcomes for appendicitis, cholecystitis, and incarcerated hernias during the first wave.Methods: A retrospective review of medical records of all patients was analysed in two groups: the non-COVID-19 group (combined 2017-2019) and the COVID-19 group (2020).Results: There were 3,316 acute emergency surgical presentations with an 8.2% decrease in total presentations in 2020. There were 477 appendicectomies, 224 cholecystectomies, and 121 repair of incarcerated hernias. All general surgical procedures demonstrated significant differences between non-COVID and COVID cohorts, including length of stay (LoS) (2.7 vs. 2.1, p=0.009) and onset of symptoms (1.6 vs. 2.2, p=0.018) for those aged less than 25 years. Patients with appendicitis aged less than 25 years had a significantly longer onset of symptoms before hospital presentation and shorter LoS in the COVID group (1.7 vs. 2.5, p=0.002; 2.9 vs. 2.3, p=0.016). Likewise, patients with cholecystitis had a significantly longer onset of symptoms in the COVID-19 cohort compared to their counterparts (2.0 vs. 3.0 days, p=0.025). There were no significant differences in biochemical, clinical or post-operative outcomes.Conclusions: The first wave of the COVID-19 pandemic significantly reduced acute general surgical presentations. For those less than 25 years in the COVID-19 cohort, overall LoS was shorter despite indicating significantly delayed presentations.

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The impact of COVID-19 on delayed presentations of necrotising fasciitis

Cited by 5 publications

References 25 publications

The Impact of the COVID-19 Pandemic on a Sydney Metropolitan Hospital Emergency Department

The Impact of the COVID-19 Pandemic on a Sydney Metropolitan Hospital Emergency Department

Lower Limb Serratia marcescens Necrotizing Fasciitis Complicated by Nosocomial COVID-19

The patterns and changes of general surgical presentations during the first wave COVID-19 pandemic at a metropolitan Sydney hospital

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