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Necrotizing Soft Tissue Infections (NSTI): Pearls and Pitfalls for the Emergency Clinician
Jessica Pelletier1, Michael Gottlieb2, Brit Long3
1Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
The Journal of Emergency Medicine
|February 4, 2022
Summary
Necrotizing soft tissue infections (NSTIs) are serious emergency department presentations that can be missed. Early recognition and surgical intervention are vital for improving outcomes in patients with these infections.
Area of Science:
- Emergency Medicine
- Infectious Diseases
- Surgical Infections
Background:
- Skin and soft tissue infections are frequent emergency department (ED) visits.
- Necrotizing soft tissue infections (NSTIs) represent a severe subset, posing significant morbidity and mortality risks.
- NSTIs are often misdiagnosed due to inconsistent clinical findings.
Purpose of the Study:
- To review the presentation, evaluation, and management of NSTIs from an ED perspective.
- To highlight the challenges in diagnosing NSTIs in emergency settings.
- To provide guidance for emergency clinicians on managing NSTIs.
Main Methods:
- Literature review of current evidence on NSTI presentation, evaluation, and management.
- Analysis of diagnostic tools including history, physical examination, laboratory tests (LRINEC score), and imaging (ultrasound, CT, MRI).
- Evaluation of treatment strategies, including surgical intervention, antibiotics, and adjuvant therapies.
Main Results:
- Clinical presentation and risk factors for NSTIs are common in ED populations but often inconsistent.
- Laboratory Risk in Necrotizing Fasciitis (LRINEC) score and imaging are useful but may delay treatment.
- Surgical exploration is the gold standard for diagnosis, with surgical intervention and broad-spectrum antibiotics forming the cornerstone of treatment.
- Adjuvant therapies like hyperbaric oxygen and IV immunoglobulin have not demonstrated proven benefits.
Conclusions:
- NSTIs are associated with high morbidity and mortality.
- Prompt recognition and management are crucial for emergency clinicians.
- Knowledge of diagnostic and treatment strategies is vital for improving patient outcomes.
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