A ten year review of necrotizing fasciitis in the paediatric population: Delays to diagnosis and management.
CPS ePoster Library. VanderMeulen H. Jun 25, 2015; 99188; 126
Heather VanderMeulen
Heather VanderMeulen
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Abstract
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Background:
Necrotizing fasciitis (NF) is a severe soft tissue infection that results in necrosis of the subcutaneous tissue and fascia. This infection, while devastating and requiring prompt recognition and management, is rare in the paediatric population. In Canada, only 2.93 cases per million youth occur annually.

Objectives:
The rarity of NF in children means that paediatric emergency physicians are less likely to be familiar with its presentation and initial management. Given that rapid identification and treatment are predictive of positive outcomes, we sought to assess the promptness and appropriateness of management in paediatric cases of NF.

Methods:
A retrospective chart review examined cases of paediatric NF treated at a paediatric tertiary care centre between 2003 and 2013. Times to antibiotic administration, arrival of consulting services, and debridement surgery were collected. We assessed the variability in the CTAS score at presentation, choice of antibiotics, total number of debridement surgeries, length of stay and resulting complications.

Results:
Among the 13 patients identified over the 10-year period, Group A Streptococcus was most commonly isolated (8 cases). The median time to administration of appropriate antibiotics was 2.8 (1.0-25.5) hours after coming to medical attention. The median times to infectious disease consults, surgical consults and debridement surgeries were 5.1 (1.1 - 42.5), 3.25 (0.4 - 28.7), and 22.1 hours (2.8 - 40.8) hours following presentation, respectively. The median length of hospital stay was 23.8 (6-49) days.

Conclusion:
This is the largest Canadian study to assess the timeliness of hospital management of NF in the paediatric population. The large variability in the care of these patients speaks to the lack of a standardized approach to their presentation. Given that prompt surgical treatment is the most important intervention to reduce NF-associated mortality, we have developed an evidence-based streamlining protocol for use in paediatric emergency departments.
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