SLR - May 2012 - Jason Kayce
Reference: Endorf, Frederick, Garrison, Michelle, et al. (2012) "Characteristics, Therapies, and Outcome of Children with Necrotizing Soft Tissue Infections." The Pediatric Infectious Disease Journal, 31.3: 221-23
Scientific Literature Review
Reviewed by: Jason Kayce, DPM
Residency Program: Cambridge Health Alliance
Podiatric Relevance:
While necrotizing soft tissue infections are uncommon, they remain potentially lethal. Historically, these infections are well described in adults; however, little is known about pediatric patients with necrotizing soft tissue infections. This article examines the characteristics, treatment patterns, and outcomes of necrotizing soft tissue infections within the pediatric population.
Methods:
A retrospective cohort study was completed through The Pediatric Health Information System database, which is comprised of 41 freestanding pediatric hospitals. Inclusion criteria was satisfied if patients were between the ages of one month to 18 years and were diagnosed with necrotizing soft tissue infections via ICD-9 codes. Procedural codes were analyzed to reveal the type and number of surgical and other clinical interventions. In addition, the time from admission to the type of surgical procedure (amputation vs. reconstruction vs. debridement) was reviewed. Analyses were performed, comparing outcome measures separately for survivors versus nonsurvivors.
Results:
The inclusion criteria identified 334 patients with necrotizing soft tissue infections, all of whom were included in this retrospective review. Overall, 22 of the 334 patients died in the hospital. The mortality group had significantly longer ICU stays, extended hospital stays, were more likely to have prolonged ventilation, and was significantly more likely to receive blood transfusions and parenteral nutrition. The mortality group demonstrated a longer time from admission to their first debridement (median, two vs one day). The time from admission to initial amputations and reconstructive surgeries were similar between the two groups. A multivariate analysis was performed to isolate independent risk factors for mortality, which included gender, age, race, type of insurance, and antibiotics prescribed, among other factors. No significant independent risk factors were identified for increased mortality.
Conclusions:
This pediatric review helps reinforce previous studies performed in the adult population, which have demonstrated that the time from admission to first debridement is critical when treating a necrotizing soft tissue infection. Though this study has its limitations, it reveals the importance in early recognition and early surgical intervention to decrease the chance of a fatal result.
Limitations within this study include a lack of disease severity markers (i.e. laboratory values), a void of surgical extent or amount of body surface involved, possible heterogeneity in coding of necrotizing soft tissue infections, and a lack of isolated organisms involved between the two groups. However, such a retrospective cohort emphasizes the need for more detailed studies in analyzing the pediatric population with regard to surgical emergencies.