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Published on: April 10, 2019
Necrotizing fasciitis in children in eastern Ontario: a case-control study
T Hsieh1, L M Samson, M Jabbour
1Faculty of Medicine, Queen's University, Kingston, Ont.
Insights
Early recognition of necrotizing fasciitis (NF) in children is crucial for survival. Differentiating NF from cellulitis involves identifying key clinical signs like rash and toxic appearance, alongside lab markers such as low platelet count.
Area of Science:
- Pediatric Infectious Diseases
- Dermatology
- Critical Care Medicine
Background:
- Necrotizing fasciitis (NF) is a severe soft-tissue infection requiring prompt treatment for improved survival.
- Distinguishing NF from less severe infections like cellulitis is challenging due to overlapping symptoms.
- Early identification of pediatric NF cases is critical for timely intervention.
Purpose of the Study:
- To investigate potential increases in pediatric necrotizing fasciitis cases over time.
- To identify clinical and laboratory features differentiating NF from cellulitis in children.
- To improve diagnostic accuracy for pediatric soft-tissue infections.
Main Methods:
- Retrospective chart review of pediatric patients with necrotizing fasciitis (NF) and cellulitis at a tertiary care hospital.
- Definition of NF confirmed by surgical or pathological examination.
- Comparison of clinical manifestations and laboratory findings between NF and cellulitis cases.
Main Results:
- Eight cases of pediatric necrotizing fasciitis were identified between 1983 and 1999, with a notable increase in later years.
- Children with NF were significantly more likely to present with a generalized erythematous rash (OR 11.0) and toxic appearance (OR 23.0) compared to cellulitis.
- NF patients exhibited higher fever, increased respiratory rate, and lower platelet counts upon presentation than cellulitis patients.
Conclusions:
- Generalized erythematous rash, toxic appearance, fever, and low platelet count are key indicators for distinguishing pediatric necrotizing fasciitis from cellulitis.
- These findings aid in the early recognition and diagnosis of NF in children.
- Prompt identification facilitates timely treatment and potentially improves patient outcomes.
Background:
Early recognition and treatment are important factors that can help improve survival following necrotizing fasciitis. However, early recognition is complicated by the difficulty in distinguishing the infection from other, less serious soft-tissue infections such as cellulitis. We reviewed the charts of children presenting with necrotizing fasciitis at a tertiary care pediatric hospital in Ontario to document potential increases in the frequency of cases and to identify clinical and laboratory features that could help distinguish between necrotizing fasciitis and cellulitis.
Methods:
Necrotizing fasciitis was defined as a soft-tissue infection characterized by necrosis of subcutaneous tissue and confirmed at surgery or on pathological examination. A retrospective chart review was conducted to identify cases of necrotizing fasciitis that occurred between June 1, 1983, and May 31, 1999. The characteristics of the identified cases, their clinical manifestations and the laboratory features at presentation were compared with those of matched controls admitted to the hospital with cellulitis.
Results:
In total, 8 cases of necrotizing fasciitis were identified during the study period. There were no cases from 1983 to 1987, 1 from 1988 to 1991, 1 from 1992 to 1995, and 6 cases from 1996 to 1999. Compared with the children who had cellulitis, those who had necrotizing fasciitis were more likely to present with a generalized erythematous rash (odds ratio [OR] 11.0; 95% confidence interval [CI] 1.5-81.6) and a toxic appearance (OR 23.0; 95% CI 2.0-262.5). They were also more likely than the children with cellulitis to have a history of fever (8/8 v. 10/24, p = 0.004), a higher temperature (mean 38.7 degrees C v. 37.8 degrees C, p = 0.006), a higher respiratory rate (mean 31.5 v. 25.4 breaths/min, p = 0.02) and a lower platelet count on presentation (mean 194.0 v. 299.3 x 10(9)/L, p = 0.03).
Interpretation:
On presentation, factors that may help distinguish necrotizing fasciitis from cellulitis include a generalized erythematous rash, toxic appearance, fever and low platelet count.
