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The Role of Computed Tomography in the Diagnosis of Necrotizing Soft Tissue Infections. World J Surg 2018 Jan;42(1):82-87

Date

08/02/2017

Pubmed ID

28762168

DOI

10.1007/s00268-017-4145-x

Scopus ID

2-s2.0-85026531411 (requires institutional sign-in at Scopus site)   37 Citations

Abstract

BACKGROUND: The exact role of IV contrast-enhanced computed tomography (CT) in the diagnosis of necrotizing soft tissue infections (NSTIs) has not yet been established. We aimed to explore the role of CT in patients with clinical suspicion of NSTI and assess its sensitivity and specificity for NSTI.

METHODS: The medical records of patients admitted between 2009 and 2016, who received IV contrast-enhanced CT to rule out NSTI, were reviewed. CT was considered positive in case of: (a) gas in soft tissues, (b) multiple fluid collections, (c) absence or heterogeneity of tissue enhancement by the IV contrast, and (d) significant inflammatory changes under the fascia. NSTI was confirmed only by the presence of necrotic tissue during surgical exploration. NSTI was considered absent if surgical exploration failed to identify necrosis, or if the patient was successfully treated non-operatively.

RESULTS: Of the 184 patients, 17 had a positive CT and hence underwent surgical exploration with NSTI being confirmed in 13 of them (76%). Of the 167 patients that had a negative CT, 38 (23%) underwent surgical exploration due to the high clinical suspicion for NSTI and were all found to have non-necrotizing infections; the remaining 129 (77%) were managed non-operatively with successful resolution of symptoms. The sensitivity of CT in identifying NSTI was 100%, the specificity 98%, the positive predictive value 76%, and the negative predictive value 100%.

CONCLUSIONS: A negative IV contrast-enhanced CT scan can reliably rule out the need for surgical intervention in patients with initial suspicion of NSTI.

Author List

Martinez M, Peponis T, Hage A, Yeh DD, Kaafarani HMA, Fagenholz PJ, King DR, de Moya MA, Velmahos GC

Author

Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Female
Humans
Male
Middle Aged
Necrosis
Retrospective Studies
Sensitivity and Specificity
Soft Tissue Infections
Tomography, X-Ray Computed