The results of three key parameters, noted during a patient’s initial presentation in the ER, may be key to identifying the presence of necrotizing soft tissue infections (NSTIs), according to data presented at the meeting (paper 18).

“Despite all the research over the last 20 or 30 years on this topic, we know that there still remains significant morbidity, as well as complications in these patients,” said Dennis Kim, MD, an assistant professor of surgery at the David Geffen School of Medicine at UCLA, in Los Angeles.

Time is of the essence in managing patients with NSTIs, Dr. Kim said. “Whether that delay in diagnosis occurs early during the patient’s presentation or there are delays to definitive operative debridement, we need to recognize these patients immediately, and we need to intervene surgically immediately.”

However, existing tools that aid in the prompt diagnosis of the infections have not proven to be particularly successful.

In order to address this, Dr. Kim and his colleagues sought to derive and validate a clinical risk index score for identifying NSTIs in EGS patients. The score would be based on clinical findings, physical examination and radiological tests performed on initial presentation in the ER.

The prospective study was conducted over 24 months, from June 2019 through September 2021, and focused on adult EGS patients with suspected NSTIs at 16 centers located across the United States. Demographics, admission vital signs and lab findings, physical examinations, and radiographic and operative findings were analyzed to identify whether signals existed that could efficiently indicate NSTIs.

A number of factors were more common among patients with NSTIs, and a logistic regression model identified three factors that were predictive of the infections: systolic blood pressure no more than 120 mm Hg (OR, 2.9), a white blood cell count of at least 15 (OR, 3.0) and violaceous skin (OR, 3.8).

“Through this multicenter, prospective observational study, we derived a fairly sensitive, highly specific risk index based upon three readily available clinical parameters to identify patients with NSTIs,” Dr. Kim concluded.