The role of radiologic evaluation in necrotizing soft tissue infections. Issue 5 (November 2016)

• Record Type: Journal Article
• Authors: Leichtle, Stefan Walter; Tung, Lily; Khan, Moazzam; Inaba, Kenji; Demetriades, Demetrios
• Is Part Of: Journal of trauma and acute care surgery. Volume 81:Issue 5(2016:Nov.)
• Publication Date: 2016-11
• Subjects: Necrotizing soft tissue infections -- necrotizing fasciitis -- diagnosis -- imaging -- radiologic evaluation; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000001244
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : BACKGROUND: The role of diagnostic imaging in suspected necrotizing soft tissue infections (NSTIs) is not clear owing to concerns about its value and possible delays in definitive surgical care. METHODS: Plain radiograph (XR) and computed tomography (CT) results of all patients who underwent operative debridement for a presumed NSTI from 2007 through 2014 at LAC + USC Medical Center were reviewed. Preoperative imaging was classified as being negative, suspicious (inflammatory changes), or diagnostic (soft tissue gas) for NSTI. RESULTS: Of 226 patients undergoing operative exploration for a suspected NSTI, 172 (76.1%) were found to have a true NSTI based on intraoperative or pathology findings. In patients with true NSTI, preoperative XR and CT demonstrated soft tissue gas in 47.9% and 70.3% of cases, respectively. CT diagnosed or highly suspected NSTI in 97.3% of cases with true NSTI compared to 83.6% with XR; p < 0.001). CONCLUSION: CT was superior to XR in the radiologic evaluation of patients with suspected NSTIs. LEVEL OF EVIDENCE: Diagnostic test, level IV.