| ORIGINAL ARTICLE
|Year : 2022 | Volume
| Issue : 5 | Page : 577-584
Morbidity and mortality of necrotizing fasciitis and their prognostic factors in children
Dilip Kumar Singh1, Rohit Kapoor1, Partap Singh Yadav1, Sonal Saxena2, Kiran Agarwal3, Ravi S Solanki4, Amit Gupta1, Subhasis Roy Choudhury1, Rajiv Chadha1
1 Department of Pediatric Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
2 Department of Microbiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
3 Department of Pathology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
4 Department of Radiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
Background: This is a prospective study of the clinico-etiologic profile and factors affecting outcomes in 40 children managed for necrotizing fasciitis (NF).
Materials and Methods: Demographic details, clinical characteristics, and laboratory parameters were recorded, and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was calculated. Primary outcome (survival vs. nonsurvival) was noted, and prognostic factors were identified.
Results: Initiating factors included boils (45%), i.v. cannula extravasations (22.5%), and blunt trauma (17.5%). Lesion (s) were predominantly on the lower limbs (35%) and trunk (25%). Twenty-two patients (55%) had <5% body surface area (BSA) involved. Severely deranged clinical and laboratory parameters were common. Ultrasound localized fluid collections. Pus cultures showed methicillin-resistant Staphylococcus aureus (52.5%), methicillin-sensitive S. aureus [27.5%], and polymicrobial growth (20%). Blood culture was positive in 24 patients (60%). Most isolates were sensitive to clindamycin and amoxy-clavulanate. Prognostic factors for mortality (n = 6; 15%) included categorization as “Sick,” BSA involvement >10%, thrombocytopenia, raised serum creatinine, late debridement, and polymicrobial blood culture isolates. All six nonsurvivors had a LRINEC score of ≥8 and positive blood cultures. Six patients (20.7%) developed unsightly scars and 5 (17.24%) contractures across joints.
Conclusions: Pediatric NF has significant morbidity and mortality. Patients with adverse prognostic factors can benefit from early referral to a facility with a critical care unit. Adequate wound management is essential to minimize residual deformity.
Partap Singh Yadav
Department of Pediatric Surgery, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi - 110 001
Source of Support: None, Conflict of Interest: None
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