TY - JOUR
T1 - The Role of Burn Centers in the Treatment of Necrotizing Soft-Tissue Infections
T2 - A Nationwide Dutch Study
AU - Suijker, Jaco
AU - Wurfbain, Lisca
AU - Emmen, Anouk M L H
AU - Pijpe, Anouk
AU - Kwa, Kelly A A
AU - van der Vlies, Cornelis H
AU - Nieuwenhuis, Marianne K
AU - van Zuijlen, Paul P M
AU - Meij-de Vries, Annebeth
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the American Burn Association.
PY - 2023/11/2
Y1 - 2023/11/2
N2 - Patients with extensive and complex wounds due to Necrotizing Soft-Tissue Infections (NSTI) may be referred to a burn center. This study describes the characteristics, outcomes, as well as diagnostic challenges of these patients. Patients admitted to three hospitals with a burn center for the treatment of NSTI in a 5-year period were included. Eighty patients (median age 54 years, 60% male) were identified, of whom 30 (38%) were referred by other centers, usually after survival of the initial septic phase. Those referred from other centers, compared to those primarily admitted to the study hospitals, were more likely to have group A streptococcal involvement (62% vs 35%, p = .02), larger wounds (median 7% vs 2% total body surface area, p < .001), and a longer length of stay (median 49 vs 22 days, p < .001). Despite a high incidence of septic shock (50%), the mortality rate was low (12%) for those primarily admitted. Approximately half (53%) of the patients were initially misdiagnosed upon presentation, which was associated with delay to first surgery (16 hours vs 4 hours, p < .001). Those initially misdiagnosed had more (severe) comorbidities, and less frequently reported pain or blue livid discoloration of the skin. This study underlines the burn centers' function as referral centers for extensively affected patients with NSTI. Besides the unique wound and reconstructive expertise, the low mortality rate indicates these centers provide adequate acute care as well. A major remaining challenge remains recognition of the disease upon presentation. Future studies in which factors associated with misdiagnosis are explored are needed.
AB - Patients with extensive and complex wounds due to Necrotizing Soft-Tissue Infections (NSTI) may be referred to a burn center. This study describes the characteristics, outcomes, as well as diagnostic challenges of these patients. Patients admitted to three hospitals with a burn center for the treatment of NSTI in a 5-year period were included. Eighty patients (median age 54 years, 60% male) were identified, of whom 30 (38%) were referred by other centers, usually after survival of the initial septic phase. Those referred from other centers, compared to those primarily admitted to the study hospitals, were more likely to have group A streptococcal involvement (62% vs 35%, p = .02), larger wounds (median 7% vs 2% total body surface area, p < .001), and a longer length of stay (median 49 vs 22 days, p < .001). Despite a high incidence of septic shock (50%), the mortality rate was low (12%) for those primarily admitted. Approximately half (53%) of the patients were initially misdiagnosed upon presentation, which was associated with delay to first surgery (16 hours vs 4 hours, p < .001). Those initially misdiagnosed had more (severe) comorbidities, and less frequently reported pain or blue livid discoloration of the skin. This study underlines the burn centers' function as referral centers for extensively affected patients with NSTI. Besides the unique wound and reconstructive expertise, the low mortality rate indicates these centers provide adequate acute care as well. A major remaining challenge remains recognition of the disease upon presentation. Future studies in which factors associated with misdiagnosis are explored are needed.
KW - humans
KW - male
KW - middel aged
KW - female
KW - burn units
KW - retrospective studies
KW - burns/complications
KW - soft tissue infections/therapy
KW - shock, septic/complications
KW - mensen
KW - mannelijk
KW - middelbare leeftijd
KW - vrouwelijk
KW - brandwonden centra
KW - retrospectieve studies
KW - brandwonden/complicaties
KW - bindweefsel infecties/therapie
KW - schok, septisch/complicaties
U2 - 10.1093/jbcr/irad073
DO - 10.1093/jbcr/irad073
M3 - Article
C2 - 37227902
SN - 1559-047X
VL - 44
SP - 1405
EP - 1412
JO - Journal of Burn Care & Research
JF - Journal of Burn Care & Research
IS - 6
ER -