Bullous skin signs and laboratory surgical indicators can quickly and effectively differentiate necrotizing fasciitis from cellulitis
Objectives: The purpose of this prospective study was to investigate the different microorganisms associated with mortality, to evaluate the bullous skin sign, and to identify the positive predictive factors for differentiating necrotizing fasciitis (NF) from cellulitis on initial onset at the emerg...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | International Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S120197122200649X |
| _version_ | 1797897283549790208 |
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| author | Yao-Hung Tsai Hung-Yen Chen Tsung-Yu Huang Jiun-Liang Chen Cheng-Ting Hsiao Kuo-Chin Huang |
| author_facet | Yao-Hung Tsai Hung-Yen Chen Tsung-Yu Huang Jiun-Liang Chen Cheng-Ting Hsiao Kuo-Chin Huang |
| author_sort | Yao-Hung Tsai |
| collection | DOAJ |
| description | Objectives: The purpose of this prospective study was to investigate the different microorganisms associated with mortality, to evaluate the bullous skin sign, and to identify the positive predictive factors for differentiating necrotizing fasciitis (NF) from cellulitis on initial onset at the emergency department. Methods: This prospective study was conducted in 145 consecutive patients with NF and 159 patients with cellulitis. Age, sex, comorbidities, infection site, microbiological results, condition of skin lesions, laboratory findings, vital signs, and clinical outcomes were compared between the two groups at the time of admission to the emergency room. Results: A total of 15 patients in the NF group and two patients in the cellulitis group died, resulting in a mortality rate of 10.3% and 1.3%, respectively. The NF group had a significantly higher incidence of white blood cell counts, band form neutrophil, and C-reactive protein than the patients in the cellulitis group. Hemorrhagic bullae presentation appeared to have significantly associated with NF and death. Conclusion: The following diagnostic indicators can be effectively used to differentiate NF from cellulitis at the initial onset: presence of hemorrhagic bullae, white blood cell counts >11,000 cells/mm3, band forms >0%, C-reactive protein >100 mg/l, and systolic blood pressure ≤90 mm Hg at the time of consultation. |
| first_indexed | 2024-04-10T07:56:07Z |
| format | Article |
| id | doaj.art-30f1d30a5e594ca6a31c6a4f500571bd |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-04-10T07:56:07Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-30f1d30a5e594ca6a31c6a4f500571bd2023-02-23T04:30:18ZengElsevierInternational Journal of Infectious Diseases1201-97122023-03-011284150Bullous skin signs and laboratory surgical indicators can quickly and effectively differentiate necrotizing fasciitis from cellulitisYao-Hung Tsai0Hung-Yen Chen1Tsung-Yu Huang2Jiun-Liang Chen3Cheng-Ting Hsiao4Kuo-Chin Huang5Department of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Taiwan, Republic of China; College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China; Corresponding author:Department of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Taiwan, Republic of ChinaCollege of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China; Division of Infectious Diseases, Department of Internal Medicine, Chia-Yi Chang Gung Memorial Hospital, Taiwan, Republic of ChinaDepartment of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Taiwan, Republic of China; College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of ChinaCollege of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of China; Department of Emergency Medicine, Chia-Yi Chang Gung Memorial Hospital, Taiwan, Republic of ChinaDepartment of Orthopaedic Surgery, Chiayi Chang Gung Memorial Hospital, Taiwan, Republic of China; College of Medicine, Chang Gung University at Taoyuan, Taiwan, Republic of ChinaObjectives: The purpose of this prospective study was to investigate the different microorganisms associated with mortality, to evaluate the bullous skin sign, and to identify the positive predictive factors for differentiating necrotizing fasciitis (NF) from cellulitis on initial onset at the emergency department. Methods: This prospective study was conducted in 145 consecutive patients with NF and 159 patients with cellulitis. Age, sex, comorbidities, infection site, microbiological results, condition of skin lesions, laboratory findings, vital signs, and clinical outcomes were compared between the two groups at the time of admission to the emergency room. Results: A total of 15 patients in the NF group and two patients in the cellulitis group died, resulting in a mortality rate of 10.3% and 1.3%, respectively. The NF group had a significantly higher incidence of white blood cell counts, band form neutrophil, and C-reactive protein than the patients in the cellulitis group. Hemorrhagic bullae presentation appeared to have significantly associated with NF and death. Conclusion: The following diagnostic indicators can be effectively used to differentiate NF from cellulitis at the initial onset: presence of hemorrhagic bullae, white blood cell counts >11,000 cells/mm3, band forms >0%, C-reactive protein >100 mg/l, and systolic blood pressure ≤90 mm Hg at the time of consultation.http://www.sciencedirect.com/science/article/pii/S120197122200649XNecrotizing fasciitisCellulitisHemorrhagic bullaeMonomicrobialGram-negative |
| spellingShingle | Yao-Hung Tsai Hung-Yen Chen Tsung-Yu Huang Jiun-Liang Chen Cheng-Ting Hsiao Kuo-Chin Huang Bullous skin signs and laboratory surgical indicators can quickly and effectively differentiate necrotizing fasciitis from cellulitis International Journal of Infectious Diseases Necrotizing fasciitis Cellulitis Hemorrhagic bullae Monomicrobial Gram-negative |
| title | Bullous skin signs and laboratory surgical indicators can quickly and effectively differentiate necrotizing fasciitis from cellulitis |
| title_full | Bullous skin signs and laboratory surgical indicators can quickly and effectively differentiate necrotizing fasciitis from cellulitis |
| title_fullStr | Bullous skin signs and laboratory surgical indicators can quickly and effectively differentiate necrotizing fasciitis from cellulitis |
| title_full_unstemmed | Bullous skin signs and laboratory surgical indicators can quickly and effectively differentiate necrotizing fasciitis from cellulitis |
| title_short | Bullous skin signs and laboratory surgical indicators can quickly and effectively differentiate necrotizing fasciitis from cellulitis |
| title_sort | bullous skin signs and laboratory surgical indicators can quickly and effectively differentiate necrotizing fasciitis from cellulitis |
| topic | Necrotizing fasciitis Cellulitis Hemorrhagic bullae Monomicrobial Gram-negative |
| url | http://www.sciencedirect.com/science/article/pii/S120197122200649X |
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