Necrotizing fasciitis in children in eastern Ontario: a case-control study.

BACKGROUND

Early recognition and treatment are important factors that can help improve survival following necrotizing fasciitis. However, early recognition is complicated by the difficulty in distinguishing the infection from other, less serious soft-tissue infections such as cellulitis. We reviewed the charts of children presenting with necrotizing fasciitis at a tertiary care pediatric hospital in Ontario to document potential increases in the frequency of cases and to identify clinical and laboratory features that could help distinguish between necrotizing fasciitis and cellulitis.

METHODS

Necrotizing fasciitis was defined as a soft-tissue infection characterized by necrosis of subcutaneous tissue and confirmed at surgery or on pathological examination. A retrospective chart review was conducted to identify cases of necrotizing fasciitis that occurred between June 1, 1983, and May 31, 1999. The characteristics of the identified cases, their clinical manifestations and the laboratory features at presentation were compared with those of matched controls admitted to the hospital with cellulitis.

RESULTS

In total, 8 cases of necrotizing fasciitis were identified during the study period. There were no cases from 1983 to 1987, 1 from 1988 to 1991, 1 from 1992 to 1995, and 6 cases from 1996 to 1999. Compared with the children who had cellulitis, those who had necrotizing fasciitis were more likely to present with a generalized erythematous rash (odds ratio [OR] 11.0; 95% confidence interval [CI] 1.5-81.6) and a toxic appearance (OR 23.0; 95% CI 2.0-262.5). They were also more likely than the children with cellulitis to have a history of fever (8/8 v. 10/24, p = 0.004), a higher temperature (mean 38.7 degrees C v. 37.8 degrees C, p = 0.006), a higher respiratory rate (mean 31.5 v. 25.4 breaths/min, p = 0.02) and a lower platelet count on presentation (mean 194.0 v. 299.3 x 10(9)/L, p = 0.03).

INTERPRETATION: On presentation, factors that may help distinguish necrotizing fasciitis from cellulitis include a generalized erythematous rash, toxic appearance, fever and low platelet count.