Alahmad Murad S, El-Menyar Ayman, Abdelrahman Husham, Abdelrahman Meiad A, Aurif Fahad, Shaikh Nissar, Al-Thani Hassan
Trauma Surgery, Hamad Medical Corporation (HMC), Hamad General Hospital (HGH), Doha, Qatar.
Clinical Research, Trauma & Vascular Surgery, HGH, PO Box 3050,, Doha, Qatar.
Eur J Trauma Emerg Surg. 2025 Mar 18;51(1):140. doi: 10.1007/s00068-025-02816-8.
Necrotizing Fasciitis (NF) is a life-threatening infection characterized by rapid tissue destruction and high mortality. The role of timely diagnosis and surgical intervention in improving patient outcomes remains debated. This study investigates the impact of "time to diagnosis" (TTD) and "time to surgical treatment" (TTS) on the outcomes of NF patients, with a specific focus on the first six hours of critical diagnosis.
A retrospective analysis was conducted for patients hospitalized with NF between June 2016 and June 2023. Demographic data, comorbidities, clinical features, treatment, and outcomes were analyzed. The study stratified patients based on TTD (early (≤ 6 h) vs. delayed (> 6 h) and TTS (≤ 6 vs. > 6 h). Outcomes included severity scores, intensive care unit admission, length of stay (LOS), and mortality.
One hundred and twenty-one patients were diagnosed with NF with a mortality rate of 10%. Early diagnosis (≤ 6 h) was associated with lower mortality (5.7% vs. 13.2%) and shorter LOS (17 vs. 27 days) compared to delayed diagnosis. Early diagnosis was associated with a lower Sequential Organ Failure Assessment (SOFA) score compared to delayed diagnosis (p = 0.02). A combined analysis of TTD and TTS revealed that the group with early diagnosis and early treatment (TTD and TTS were ≤ 6 h) had a 3% mortality rate, and 7% of them had a SOFA score > 9. In contrast, delayed diagnosis (TTD > 6 h) was significantly associated with increased mortality, regardless of the TTS.
Timely diagnosis within 6 h is crucial for improving outcomes in NF. While early surgical intervention is vital, our findings suggest that the time to diagnosis and subsequent resuscitation efforts may significantly impact survival. This study highlights the importance of optimizing early recognition and diagnosis in the emergency room to reduce delays and improve patient prognosis in NF. Further multicenter studies are needed to validate these findings and refine clinical protocols.
坏死性筋膜炎（NF）是一种危及生命的感染，其特征为组织快速破坏且死亡率高。及时诊断和手术干预对改善患者预后的作用仍存在争议。本研究调查了“诊断时间”（TTD）和“手术治疗时间”（TTS）对NF患者预后的影响，特别关注关键诊断的前六个小时。
对2016年6月至2023年6月期间因NF住院的患者进行回顾性分析。分析人口统计学数据、合并症、临床特征、治疗及预后。该研究根据TTD（早期（≤6小时）与延迟（>6小时））和TTS（≤6与>6小时）对患者进行分层。预后指标包括严重程度评分、重症监护病房入住情况、住院时间（LOS）和死亡率。
121例患者被诊断为NF，死亡率为10%。与延迟诊断相比，早期诊断（≤6小时）与较低的死亡率（5.7%对13.2%）和较短的住院时间（17天对27天）相关。与延迟诊断相比，早期诊断的序贯器官衰竭评估（SOFA）评分更低（p = 0.02）。TTD和TTS的综合分析显示，早期诊断并早期治疗组（TTD和TTS均≤6小时）的死亡率为3%，其中7%的患者SOFA评分>9。相比之下，无论TTS如何，延迟诊断（TTD>6小时）均与死亡率增加显著相关。
6小时内及时诊断对改善NF患者的预后至关重要。虽然早期手术干预至关重要，但我们的研究结果表明，诊断时间和随后的复苏努力可能会显著影响生存率。本研究强调了在急诊室优化早期识别和诊断以减少延迟并改善NF患者预后的重要性。需要进一步的多中心研究来验证这些发现并完善临床方案。
