Presentation Title

Point-of-Care Ultrasound in the Diagnosis of Necrotizing Fasciitis

Faculty Mentor

John C. Fox, Shadi Lahham, Inna Shniter

Start Date

17-11-2018 8:45 AM

End Date

17-11-2018 9:00 AM

Location

C304

Session

Oral 1

Type of Presentation

Oral Talk

Subject Area

health_nutrition_clinical_science

Abstract

The purpose of this study is to determine if necrotizing fasciitis can be accurately diagnosed using point-of-care ultrasound (POCUS).

We prospectively enrolled adult patients in the Emergency Department (ED) who were suspected of having necrotizing fasciitis. This included patients presenting with signs of severe soft tissue infection who would be getting a surgical consult and/or CT scan as part of their evaluation. All patients enrolled in the study received a point-of-care soft tissue ultrasound performed by the ED physician. An ultrasound fellowship-trained ED physician who was blind to the clinical data later reviewed and interpreted the ultrasound clips as concerning for necrotizing fasciitis or not concerning for necrotizing fasciitis. This determination was based on the presence or absence of gas in the tissue. The gold standard for confirming the diagnosis was surgical exploration.

10 patients have been enrolled in the study. Nine patients were used for data analysis. Three patients were diagnosed with necrotizing fasciitis perioperatively, all of which had ultrasounds that were interpreted as concerning for necrotizing fasciitis. Two patients had perioperative diagnoses of non-necrotizing infections and three patients were diagnosed with cellulitis based on Computed Tomography (CT) scan only. These five patients had ultrasounds that were interpreted as not concerning for necrotizing fasciitis.

Our preliminary data suggests that POCUS can be used to aid in the diagnosis of necrotizing fasciitis. Additional patients will be required to validate these findings and determine the sensitivity and specificity of this imaging modality.

Summary of research results to be presented

This research study is still enrolling patients. Thus far, 10 patients have been enrolled in the study. Of these ten patients, nine were used for data analysis. One patient was excluded due to technically inadequate ultrasound images. Three patients were diagnosed with necrotizing fasciitis perioperatively, 100% which had ultrasounds that were interpreted as concerning for necrotizing fasciitis. Two patients had perioperative diagnoses of non-necrotizing infections and three patients were diagnosed with cellulitis based on Computed Tomography (CT) scan only. Of these five patients who were deemed to have non-necrotizing infections based on surgical exploration or advanced imaging, 100% had ultrasounds that were interpreted as not concerning for necrotizing fasciitis.

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Nov 17th, 8:45 AM Nov 17th, 9:00 AM

Point-of-Care Ultrasound in the Diagnosis of Necrotizing Fasciitis

C304

The purpose of this study is to determine if necrotizing fasciitis can be accurately diagnosed using point-of-care ultrasound (POCUS).

We prospectively enrolled adult patients in the Emergency Department (ED) who were suspected of having necrotizing fasciitis. This included patients presenting with signs of severe soft tissue infection who would be getting a surgical consult and/or CT scan as part of their evaluation. All patients enrolled in the study received a point-of-care soft tissue ultrasound performed by the ED physician. An ultrasound fellowship-trained ED physician who was blind to the clinical data later reviewed and interpreted the ultrasound clips as concerning for necrotizing fasciitis or not concerning for necrotizing fasciitis. This determination was based on the presence or absence of gas in the tissue. The gold standard for confirming the diagnosis was surgical exploration.

10 patients have been enrolled in the study. Nine patients were used for data analysis. Three patients were diagnosed with necrotizing fasciitis perioperatively, all of which had ultrasounds that were interpreted as concerning for necrotizing fasciitis. Two patients had perioperative diagnoses of non-necrotizing infections and three patients were diagnosed with cellulitis based on Computed Tomography (CT) scan only. These five patients had ultrasounds that were interpreted as not concerning for necrotizing fasciitis.

Our preliminary data suggests that POCUS can be used to aid in the diagnosis of necrotizing fasciitis. Additional patients will be required to validate these findings and determine the sensitivity and specificity of this imaging modality.