Diagnosis of necrotizing soft tissue infections by computed tomography. Arch Surg 2010 May;145(5):452-5
Date
05/19/2010Pubmed ID
20479343DOI
10.1001/archsurg.2010.50Scopus ID
2-s2.0-77952415961 (requires institutional sign-in at Scopus site) 99 CitationsAbstract
HYPOTHESIS: In contrast to previous beliefs, we hypothesize that computed tomography (CT) scanning is sensitive and specific for the diagnosis of necrotizing soft tissue infections (NSTIs).
DESIGN: Retrospective and prospective case series.
SETTING: Academic medical center.
PATIENTS: Patients who were clinically suspected of having NSTIs from January 1, 2003, through April 30, 2009, and who underwent imaging with a 16- or 64-section helical CT scanner were studied. The CT result was considered positive if inflamed and necrotic tissue with or without gas or fluid collections across tissue planes was found. The disease (NSTI) was considered present if surgical exploration revealed elements of infection and necrosis of the soft tissues and pathological analysis confirmed the findings. The disease was considered absent if surgical exploration and pathological analysis failed to identify any of these findings or the patient was successfully treated without surgical exploration.
MAIN OUTCOME MEASURES: Sensitivity and specificity of CT for diagnosing NSTI.
RESULTS: Of 67 patients with study inclusion criteria, 58 underwent surgical exploration, and NSTI was confirmed in 25 (43%). The remaining 42 patients had either nonnecrotizing infections during surgical exploration (n = 33) or were treated nonoperatively with successful resolution of the symptoms (n = 9). The sensitivity of CT to identify NSTI was 100%, specificity was 81%, positive predictive value was 76%, and negative predictive value was 100%. No differences were found in demographics, white blood cell count on admission, symptoms, or site of infection between those with a false- or true-positive CT result.
CONCLUSIONS: A negative CT result reliably excludes the diagnosis of NSTI. A positive CT result correctly identifies the disease with a high likelihood.
Author List
Zacharias N, Velmahos GC, Salama A, Alam HB, de Moya M, King DR, Novelline RAAuthor
Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Cohort Studies
Fascia
Female
Humans
Male
Middle Aged
Muscles
Necrosis
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Soft Tissue Infections
Subcutaneous Tissue
Tomography, X-Ray Computed
Young Adult
