A systematic review of necrotising fasciitis in children from its first description in 1930 to 2018.

Gregory B Firth
Gregory B Firth
Children's Hospital of Eastern Ontario
Andrew Grieve
Andrew Grieve
ICON Adaptive Trials Innovation Centre

BMC Infect Dis 2019 Apr 11;19(1):317. Epub 2019 Apr 11.

Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, 26 Chris Hani Road, Johannesburg, ZA-1860, South Africa.

Background: Necrotising fasciitis is a rapidly progressing soft-tissue infection with a low incidence that carries a relevant risk of morbidity and mortality. Although necrotising fasciitis is often fatal in adults, its case fatality rate seems to be lower in children. A highly variable clinical presentation makes the diagnosis challenging, which often results in misdiagnosis and time-delay to therapy.

Methods: We conducted a protocol-based systematic review to identify specific features of necrotising fasciitis in children aged one month to 17 years. We searched 'PubMed', 'Web of Science' and 'SCOPUS' for relevant literature. Primary outcomes were incidence and case fatality rates in population-based studies, and skin symptoms on presentation. We also assessed signs of systemic illness, causative organisms, predisposing factors, and reconstructive procedures as secondary outcomes.

Results: We included five studies reporting incidence and case fatality rates, two case-control studies, and 298 cases from 195 reports. Incidence rates varied between 0.022 and 0.843 per 100,000 children per year with a case-fatality rate ranging from 0% to 14.3%. The most frequent skin symptoms were erythema (58.7%; 175/298) and swelling (48%; 143/298), whereas all other symptoms occurred in less than 50% of cases. The majority of cases had fever (76.7%; 188/245), but other signs of systemic illness were present in less than half of the cohort. Group-A streptococci accounted for 44.8% (132/298) followed by Gram-negative rods in 29.8% (88/295), while polymicrobial infections occurred in 17.3% (51/295). Extremities were affected in 45.6% (136/298), of which 73.5% (100/136) occurred in the lower extremities. Skin grafts were necessary in 51.6% (84/162) of the pooled cases, while flaps were seldom used (10.5%; 17/162). The vast majority of included reports originate from developed countries.

Conclusions: Clinical suspicion remains the key to diagnose necrotising fasciitis. A combination of swelling, pain, erythema, and a systemic inflammatory response syndrome might indicate necrotising fasciitis. Incidence and case-fatality rates in children are much smaller than in adults, although there seems to be a relevant risk of morbidity indicated by the high percentage of skin grafts. Systematic multi-institutional research efforts are necessary to improve early diagnosis on necrotising fasciits.

Download full-text PDF

http://dx.doi.org/10.1186/s12879-019-3941-3DOI Listing
April 2019
3 Reads

Publication Analysis

Top Keywords

necrotising fasciitis
case fatality
incidence case
risk morbidity
fatality rates
skin grafts
signs systemic
skin symptoms
relevant risk
systemic illness
systematic review
fasciitis children
rates varied
0022 0843
clinical suspicion
varied 0022


(Supplied by CrossRef)
Article in Lancet Infect Dis
LEM Lamb et al.
Lancet Infect Dis 2015
Article in Am J Dis Child
HD Wilson et al.
Am J Dis Child 1973
Article in J Oklahoma State Med Assoc
C Hardzog-Britt et al.
J Oklahoma State Med Assoc 1995
Article in Ann Surg
FL Meleney et al.
Ann Surg 1930
Article in Arch Surg
FL Meleney et al.
Arch Surg 1924
Article in Pediatr Clin N Am
G Frank et al.
Pediatr Clin N Am 2005
Article in Pediatr Ann
AKC Leung et al.
Pediatr Ann 2008
Article in J Wound Care
A Pandey et al.
J Wound Care 2008
Article in Pediatr Emerg Care
N Jamal et al.
Pediatr Emerg Care 2011
Article in British Journal of Dermatology
E. Audureau et al.
British Journal of Dermatology 2017
Article in Bone Jt J
JH Tan et al.
Bone Jt J 2016

Similar Publications