Three Ds for diagnosing necrotizing fasciitis by front-line clinicians

Area of Science:

• Emergency Medicine
• Infectious Diseases
• Surgical Pathology

Background:

• Necrotizing fasciitis (NF) is a severe, rapidly progressing infection requiring immediate surgical intervention.
• Early diagnosis of NF is challenging for clinicians lacking specialized experience or resources.

Purpose of the Study:

• To develop a diagnostic algorithm for primary care and emergency physicians to identify patients with possible NF.
• To create a triage approach for suspected NF cases.

Main Methods:

• Systematic literature search of Medline for validated NF diagnostic algorithms and clinical features.
• Development of the "3Ds" algorithm: Disproportionate pain, Dermatological findings, and Disorganized physiology.
• Validation of the algorithm using published misdiagnosed NF cases and retrospective review of 56 local NF cases (2011-2022).

Main Results:

• No previously validated NF diagnostic algorithm was identified in the literature.
• The "3Ds" algorithm was developed based on reported NF clinical and diagnostic features.
• The algorithm correctly identified 3 published misdiagnosed NF cases and was present in 66% of 56 retrospectively reviewed NF cases at initial presentation.

Conclusions:

• The "3Ds" algorithm offers a simple, memorable tool for improving early NF diagnosis in primary and emergency care settings.
• Retrospective validation supports the algorithm's utility, but prospective validation is required.