A comparison of outcomes between transferred patients versus patients who presented directly to the emergency department with necrotizing fasciitis.

Introduction: Necrotizing Fasciitis (NF) is a rare life-threatening bacterial infection that necessitates emergent resuscitation and operative intervention. Most of the literature has emphasized the need for early surgical intervention. This is problematic for patients being treated at a facility lacking surgical support, with concerns for increasing mortality and morbidity rates.

Methods: This is a 10-year retrospective study of emergency department (ED) documentation and surgical operative reports of patients seen at Arrowhead Regional Medical Center from January 1, 2011, to December 31, 2020. The patients were divided into two groups: the Transfer Group (TG), consisting of those transferred from another facility, and the Direct Admit Group (DAG), comprising those who presented directly to the ED. A comparison was conducted to identify statistically significant differences between the 2 groups of patients with a final diagnosis of NF, with specific emphasis on mortality rate, hospital length of stay (LOS), and intensive care unit (ICU) LOS.

Results: A total of 134 patients with a confirmed diagnosis of NF were included in the final analysis. More than half (50.8%, n = 68) of the patients presented as transfers from area hospitals. Compared to the DAG, the TG had a significantly higher percentage of patients undergoing surgical intervention within six hours of ED presentation (95.6% vs. 10.6%, respectively; p < 0.0001). The TG had a lower mortality rate compared to the DAG (11.8% vs. 22.7%), though the difference did not reach statistical significance. There was no statistically significant difference in hospital LOS (13 days vs. 13.5 days, p = 0.9046) or ICU LOS (3 days for both groups, p = 0.4845) between these two groups.

Conclusion: Aggressive management with broad-spectrum antibiotics and intravenous fluid resuscitation may mitigate the effect on mortality in patients with necrotizing fasciitis when prompt surgical intervention is not available.