{"id":1674,"date":"2020-07-22T08:00:00","date_gmt":"2020-07-22T08:00:00","guid":{"rendered":"http:\/\/emultrasound.sdsc.edu\/?p=1674"},"modified":"2021-05-04T16:54:42","modified_gmt":"2021-05-04T16:54:42","slug":"usfindingsinnecfasc","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2020\/07\/22\/usfindingsinnecfasc\/","title":{"rendered":"Can Fluid Accumulation on Ultrasound Diagnose Necrotizing Fasciitis?"},"content":{"rendered":"
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Background<\/h2>\n

Necrotizing fasciitis (NF) is rapidly progressing, severe soft tissue infection with a mortality rate of 19.3% with treatment and significantly higher without treatment (1). Early diagnosis is essential to prompt surgical intervention and reduce morbidity and mortality. However, treatment can often be delayed because no laboratory or imaging test can definitively diagnose NF. Contrast-enhanced CT shows the best accuracy, but again is not perfect and can be difficult to obtain in unstable patients. MRI is similarly accurate, but even less feasible in the Emergency Department. Ultimately, it remains a surgical diagnosis.<\/span><\/p>\n

Ultrasonography is a rapid, bedside, and non-invasive tool that has potential to accelerate assessment of patient with clinical suspicion for NF. There are ultrasonographic findings associated with NF diagnosis, including irregularity or thickening of deep fascia, subcutaneous emphysema, and fluid accumulation along the deep fascial plane (2-13). Considering this condition’s rapid progression, ultrasonography may enable physicians to quickly gauge disease severity and triage accordingly, prompting earlier surgery and bettering patient outcomes.<\/p>\n

The Relationship Between Fluid Accumulation in Ultrasonography and Diagnosis and Prognosis of Patients with Necrotizing Fasciitis<\/a><\/p>\n

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Clinical Question<\/h3>
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What is the relationship between ultrasonographic finding of fluid accumulation along the deep fascia and diagnosis and prognosis of necrotizing fasciitis?<\/span><\/p>\n

What ultrasonographic findings are significantly different between NF patients and non-NF patients?<\/span><\/p>\n

What is the ultrasonographic-detected depth of fluid accumulation along the deep fascia that offers the greatest accuracy to diagnosis of NF?<\/span><\/p>\n

Is there a difference in the prognosis between NF patients with fluid accumulation compared to NF patients without fluid accumulation?\u00a0<\/span><\/p>\n<\/div><\/div>\n

Methods & Study Design<\/h3>
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\u2022 Design\u00a0<\/b><\/span><\/p>\n

Retrospective study with prospective enrollment<\/span><\/p>\n

\u2022 Population\u00a0<\/b><\/span><\/p>\n

This study was conducted at Chang Gung Memorial Hospital, a suburban academic tertiary care hospital.<\/span><\/p>\n

Inclusion criteria: patients who visited the ED from February 2015 \u2013 November 2016 with clinical suspicion of NF of limbs based on symptoms and clinical signs (severe pain out of proportion, skin findings, rapid progression, crepitus, skin bullae, necrosis, or ecchymosis).<\/span><\/p>\n

NF group<\/span><\/i>: discharge diagnosis of NF, confirmed by pathology report showing necrosis after surgical intervention<\/span><\/p>\n

Non-NF group<\/span><\/i>: did not have surgical intervention or whose pathology report did not support NF diagnosis<\/span><\/p>\n

Exclusion criteria: patients with ED visits between 24:00 \u2013 7:00, non-lesion side also has fluid accumulation, age <18yo, prior antibiotics or debridement, lesions involving trunk area<\/span><\/p>\n

\u2022 Intervention\u00a0<\/b><\/span><\/p>\n

Ultrasonographic exam within 1 hour after ED arrival completed by one of three experienced emergency physicians who received an 8-hour basic and soft-tissue ultrasonographic training before the study<\/span><\/p>\n

Orthopedic consult for surgical opinion<\/span><\/p>\n

\u2022 Outcomes\u00a0\u00a0<\/b><\/span><\/p>\n