Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois.
J Emerg Med. 2022 Apr;62(4):480-491. doi: 10.1016/j.jemermed.2021.12.012. Epub 2022 Jan 31.
Skin and soft tissue infections are common emergency department (ED) presentations. These infections cover a wide spectrum of disease, from simple cellulitis to necrotizing fasciitis. Despite the commonality, a subset of skin and soft tissue infections known as necrotizing soft tissue infections (NSTIs) can cause significant morbidity and mortality.
This review evaluates the current evidence regarding the presentation, evaluation, and management of NSTI from the ED perspective.
NSTIs are commonly missed diagnoses. History and physical examination findings are inconsistent, and the risk factors for this high mortality disease are common amongst ED populations. Laboratory evaluation and the Laboratory Risk in Necrotizing Fasciitis (LRINEC) score is helpful but is insufficient to rule out the disease. Imaging modalities including ultrasound, computed tomography, and magnetic resonance imaging are highly sensitive and specific, but may delay definitive management. The gold standard for diagnosis includes surgical exploration. Surgical intervention and empiric broad-spectrum antibiotic coverage are the foundations of treatment. Adjuvant therapies including hyperbaric oxygen and intravenous immunoglobulin have not yet been proven to be beneficial or to improve outcome.
NSTIs are associated with significant morbidity and mortality. Knowledge of the history, examination, evaluation, and management is vital for emergency clinicians.
皮肤和软组织感染是常见的急诊（ED）就诊原因。这些感染涵盖了广泛的疾病谱，从单纯的蜂窝织炎到坏死性筋膜炎。尽管很常见，但一部分被称为坏死性软组织感染（NSTI）的皮肤和软组织感染可能导致严重的发病率和死亡率。
本综述从 ED 角度评估了关于 NSTI 的表现、评估和管理的现有证据。
NSTI 常被漏诊。病史和体格检查结果不一致，这种高死亡率疾病的危险因素在 ED 人群中很常见。实验室评估和坏死性筋膜炎的实验室风险指数（LRINEC）评分有一定帮助，但不足以排除该疾病。超声、计算机断层扫描和磁共振成像等影像学检查方法具有高度的敏感性和特异性，但可能会延迟明确的治疗。诊断的金标准包括手术探查。手术干预和经验性广谱抗生素覆盖是治疗的基础。辅助治疗，包括高压氧和静脉注射免疫球蛋白，尚未被证明有益或能改善预后。
NSTI 与显著的发病率和死亡率相关。了解病史、检查、评估和管理对急诊临床医生至关重要。
