Neeki Michael M, Dong Fanglong, Tran Louis, Malkoc Aldin, Kim Joseph, Neeki Sarah C, Patel Suraj, Senewiratne Niluk Leon, Ma Mariel, Wong Cynthis, Borger Rodney, Wong David
Department of Emergency Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Ave, Colton, CA, 92324, USA.
Department of Surgery, Arrowhead Regional Medical Center, Colton, CA, USA.
Int J Emerg Med. 2025 Mar 10;18(1):49. doi: 10.1186/s12245-025-00848-w.
Necrotizing Fasciitis (NF) is a rare life-threatening bacterial infection that necessitates emergent resuscitation and operative intervention. Most of the literature has emphasized the need for early surgical intervention. This is problematic for patients being treated at a facility lacking surgical support, with concerns for increasing mortality and morbidity rates.
This is a 10-year retrospective study of emergency department (ED) documentation and surgical operative reports of patients seen at Arrowhead Regional Medical Center from January 1, 2011, to December 31, 2020. The patients were divided into two groups: the Transfer Group (TG), consisting of those transferred from another facility, and the Direct Admit Group (DAG), comprising those who presented directly to the ED. A comparison was conducted to identify statistically significant differences between the 2 groups of patients with a final diagnosis of NF, with specific emphasis on mortality rate, hospital length of stay (LOS), and intensive care unit (ICU) LOS.
A total of 134 patients with a confirmed diagnosis of NF were included in the final analysis. More than half (50.8%, n = 68) of the patients presented as transfers from area hospitals. Compared to the DAG, the TG had a significantly higher percentage of patients undergoing surgical intervention within six hours of ED presentation (95.6% vs. 10.6%, respectively; p < 0.0001). The TG had a lower mortality rate compared to the DAG (11.8% vs. 22.7%), though the difference did not reach statistical significance. There was no statistically significant difference in hospital LOS (13 days vs. 13.5 days, p = 0.9046) or ICU LOS (3 days for both groups, p = 0.4845) between these two groups.
Aggressive management with broad-spectrum antibiotics and intravenous fluid resuscitation may mitigate the effect on mortality in patients with necrotizing fasciitis when prompt surgical intervention is not available.
坏死性筋膜炎（NF）是一种罕见的危及生命的细菌感染，需要紧急复苏和手术干预。大多数文献都强调了早期手术干预的必要性。对于在缺乏手术支持的机构接受治疗的患者来说，这存在问题，因为人们担心死亡率和发病率会增加。
这是一项对2011年1月1日至2020年12月31日在箭头区域医疗中心就诊的患者的急诊科（ED）记录和手术报告进行的为期10年的回顾性研究。患者分为两组：转院组（TG），由从其他机构转来的患者组成；直接入院组（DAG），由直接到急诊科就诊的患者组成。对两组最终诊断为NF的患者进行比较，以确定统计学上的显著差异，特别关注死亡率、住院时间（LOS）和重症监护病房（ICU）住院时间。
共有134例确诊为NF的患者纳入最终分析。超过一半（50.8%，n = 68）的患者是从地区医院转来的。与直接入院组相比，转院组在急诊科就诊后6小时内接受手术干预的患者比例显著更高（分别为95.6%和10.6%；p < 0.0001）。转院组的死亡率低于直接入院组（11.8%对22.7%），尽管差异未达到统计学显著性。两组之间的住院时间（13天对13.5天，p = 0.9046）或重症监护病房住院时间（两组均为3天，p = 0.4845）没有统计学上的显著差异。
当无法及时进行手术干预时，使用广谱抗生素和静脉液体复苏进行积极治疗可能会减轻坏死性筋膜炎患者的死亡率。
