The role of radiologic evaluation in necrotizing soft tissue infections.

Authors :: Leichtle SW
Tung L
Khan M
Inaba K
Demetriades D
Source :: The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2016 Nov; Vol. 81 (5), pp. 921-924.
Publication Year :: 2016
Abstract: Background: The role of diagnostic imaging in suspected necrotizing soft tissue infections (NSTIs) is not clear owing to concerns about its value and possible delays in definitive surgical care.<br />Methods: Plain radiograph (XR) and computed tomography (CT) results of all patients who underwent operative debridement for a presumed NSTI from 2007 through 2014 at LAC + USC Medical Center were reviewed. Preoperative imaging was classified as being negative, suspicious (inflammatory changes), or diagnostic (soft tissue gas) for NSTI.<br />Results: Of 226 patients undergoing operative exploration for a suspected NSTI, 172 (76.1%) were found to have a true NSTI based on intraoperative or pathology findings. In patients with true NSTI, preoperative XR and CT demonstrated soft tissue gas in 47.9% and 70.3% of cases, respectively. CT diagnosed or highly suspected NSTI in 97.3% of cases with true NSTI compared to 83.6% with XR; p < 0.001).<br />Conclusion: CT was superior to XR in the radiologic evaluation of patients with suspected NSTIs.<br />Level of Evidence: Diagnostic test, level IV.