Joyce Lunar1, Sinkeet S Ranketi1, Beverly Owino1, Mark Oloo1, Robert K Parker2,3. 1. Department of Surgery, Tenwek Hospital, P.O. Box 39, Bomet, 20400, Kenya. 2. Department of Surgery, Tenwek Hospital, P.O. Box 39, Bomet, 20400, Kenya. robert_k_parker@brown.edu. 3. Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA. robert_k_parker@brown.edu.
Abstract
BACKGROUND: Necrotizing fasciitis (NF) is a devastating disease with substantial morbidity and mortality. Poor outcomes are attributed to delayed diagnosis and management. Tenwek Hospital, a teaching and referral center in rural Kenya, manages many cases despite variable resources. We aimed to understand the burden of NF. METHODS: All patients with admission NF diagnosis who presented in 2017 were reviewed for demographics, investigations, treatment, and outcomes. The primary outcome was unfavorable outcome defined as in-hospital mortality or amputation. Secondary outcomes were discharge diagnosis of NF and cost. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was calculated. Logistic regression models were utilized to assess the impact of risk factors. RESULTS: Sixty-seven patients were identified with an average age of 49.2 (±21) years. Medical comorbidities were present in 48% and history of trauma in 58%. Discharge diagnosis of NF occurred in 61% (N = 41). Overall, mortality occurred in 10% (N = 7) of patients with an initial NF diagnosis. At discharge, patients without NF had favorable outcomes in 96% (N = 25) compared to 78% (N = 32) with NF (p = 0.043). Final NF diagnosis costs 122,098 Kenyan Shillings more (95% confidence interval 36,142-208,054) than non-NF diagnosis (p value = 0.006). Factors associated with unfavorable outcome include diabetes mellitus, any comorbidity, increased heart rate, fever, hyperglycemia, anemia, and discharge NF diagnosis. Increased LRINEC score was associated with discharge NF diagnosis (p = 0.0006) and unfavorable outcome (p = 0.0157). CONCLUSIONS: Patients with NF in rural Kenya experience delays to presentation, unfavorable outcomes, and substantial costs. Certain factors, including LRINEC score, help predict diagnosis and outcome.
BACKGROUND: Necrotizing fasciitis (NF) is a devastating disease with substantial morbidity and mortality. Poor outcomes are attributed to delayed diagnosis and management. Tenwek Hospital, a teaching and referral center in rural Kenya, manages many cases despite variable resources. We aimed to understand the burden of NF. METHODS: All patients with admission NF diagnosis who presented in 2017 were reviewed for demographics, investigations, treatment, and outcomes. The primary outcome was unfavorable outcome defined as in-hospital mortality or amputation. Secondary outcomes were discharge diagnosis of NF and cost. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was calculated. Logistic regression models were utilized to assess the impact of risk factors. RESULTS: Sixty-seven patients were identified with an average age of 49.2 (±21) years. Medical comorbidities were present in 48% and history of trauma in 58%. Discharge diagnosis of NF occurred in 61% (N = 41). Overall, mortality occurred in 10% (N = 7) of patients with an initial NF diagnosis. At discharge, patients without NF had favorable outcomes in 96% (N = 25) compared to 78% (N = 32) with NF (p = 0.043). Final NF diagnosis costs 122,098 Kenyan Shillings more (95% confidence interval 36,142-208,054) than non-NF diagnosis (p value = 0.006). Factors associated with unfavorable outcome include diabetes mellitus, any comorbidity, increased heart rate, fever, hyperglycemia, anemia, and discharge NF diagnosis. Increased LRINEC score was associated with discharge NF diagnosis (p = 0.0006) and unfavorable outcome (p = 0.0157). CONCLUSIONS: Patients with NF in rural Kenya experience delays to presentation, unfavorable outcomes, and substantial costs. Certain factors, including LRINEC score, help predict diagnosis and outcome.
Authors: Massimo Sartelli; Mark A Malangoni; Addison K May; Pierluigi Viale; Lillian S Kao; Fausto Catena; Luca Ansaloni; Ernest E Moore; Fred A Moore; Andrew B Peitzman; Raul Coimbra; Ari Leppaniemi; Yoram Kluger; Walter Biffl; Kaoru Koike; Massimo Girardis; Carlos A Ordonez; Mario Tavola; Miguel Cainzos; Salomone Di Saverio; Gustavo P Fraga; Igor Gerych; Michael D Kelly; Korhan Taviloglu; Imtiaz Wani; Sanjay Marwah; Miklosh Bala; Wagih Ghnnam; Nissar Shaikh; Osvaldo Chiara; Mario Paulo Faro; Gerson Alves Pereira; Carlos Augusto Gomes; Federico Coccolini; Cristian Tranà; Davide Corbella; Pietro Brambillasca; Yunfeng Cui; Helmut A Segovia Lohse; Vladimir Khokha; Kenneth Yy Kok; Suk-Kyung Hong; Kuo-Ching Yuan Journal: World J Emerg Surg Date: 2014-11-18 Impact factor: 5.469
Authors: Sander F L van Stigt; Janneke de Vries; Jilles B Bijker; Roland M H G Mollen; Edo J Hekma; Susan M Lemson; Edward C T H Tan Journal: World J Emerg Surg Date: 2016-05-27 Impact factor: 5.469