Frazee Bradley W, Fee Christopher, Lynn Jeremy, Wang Ralph, Bostrom Alan, Hargis Cherie, Moore Paul
Department of Emergency Medicine, Alameda County Medical Center - Highland Hospital, Oakland, California, USA.
J Emerg Med. 2008 Feb;34(2):139-46. doi: 10.1016/j.jemermed.2007.03.041. Epub 2007 Aug 29.
To characterize the Emergency Department (ED) presentation of necrotizing soft tissue infections (NSTI) and identify severity markers.
Retrospective chart review of pathologically diagnosed NSTIs presenting to an urban ED from 1990-2001. Cases were identified from a surgical database, ICD-9 search and prospectively. Five Emergency Physicians (EPs) abstracted data using a standardized form. Severe NSTI was defined by any of the following: death, amputation, intensive care unit (ICU) stay >24 h, >300 cm(2) debrided. Severe and non-severe cases were compared using chi-square, Fisher's exact, and multivariate logistic regression testing.
The 122 cases were characterized by: injection drug use, 80%; fever, 44%; systolic blood pressure (BP) <100 mm Hg, 21%; white blood cell count (WBC) >20 x 10(9)/L, 43%; median time to operation, 8.4 h; mortality, 16%. The managing EP suspected NSTI in 59%. A systolic BP <100 mm Hg, BUN >18 mg/dL, radiographic soft tissue gas, admission to a non-surgical service and clostridial species were independently associated with severe NSTI.
Pathologically defined NSTIs have a wide spectrum of ED presentations and early diagnosis remains difficult.
描述急诊科坏死性软组织感染（NSTI）的临床表现并确定严重程度标志物。
对1990年至2001年在城市急诊科就诊的经病理诊断的NSTI病例进行回顾性病历审查。病例从手术数据库、ICD-9检索中识别，并进行前瞻性研究。五名急诊医师（EP）使用标准化表格提取数据。严重NSTI定义为以下任何一种情况：死亡、截肢、重症监护病房（ICU）住院时间>24小时、清创面积>300平方厘米。使用卡方检验、费舍尔精确检验和多因素逻辑回归检验对严重和非严重病例进行比较。
122例病例的特征如下：注射吸毒者占80%；发热占44%；收缩压（BP）<100mmHg占21%；白细胞计数（WBC）>20×10⁹/L占43%；中位手术时间为8.4小时；死亡率为16%。59%的急诊医师怀疑为NSTI。收缩压<100mmHg、血尿素氮>18mg/dL、影像学显示软组织积气、入住非手术科室以及梭菌属与严重NSTI独立相关。
病理定义的NSTI在急诊科有广泛的临床表现，早期诊断仍然困难。
