126: A Ten Year Review of Necrotizing Fasciitis in the Paediatric Population: Delays to Diagnosis and Management

Necrotizing fasciitis (NF) is a severe soft tissue infection that results in necrosis of the subcutaneous tissue and fascia. This infection, while devastating and requiring prompt recognition and management, is rare in the paediatric population. In Canada, only 2.93 cases per million youth occur annually. There has not been a dedicated Canadian paediatric study of necrotizing fasciitis management to date. The rarity of NF in children means that emergency physicians are less likely to be familiar with its presentation and initial management. Given that rapid identification and treatment are predictive of positive outcomes, we sought to assess the promptness and appropriateness of management in paediatric cases of NF. A retrospective chart review examined cases of paediatric NF treated at two tertiary care centres between 2003 and 2013. Times to antibiotic administration, arrival of consulting services, and debridement surgery were collected. The variability in the CTAS score at presentation, choice of antibiotics, total number of debridement surgeries, length of stay and resulting complications were assessed. Among the 13 patients identified over the 10-year period, Group A Streptococcus was most commonly isolated (8 cases). Appropriate antibiotics were administered on average 4.6 hours (range 1.0 – 25.5 hours) after presentation to the emergency department. The mean times to infectious disease and surgical consults were 13.2 hours (range 1.1 – 42.5 hours) and 9.8 hours (range 0.4 – 28.7 hours), respectively. Debridement surgeries were performed, on average, 21 hours (range 2.8 – 40.8 hours) after presentation. The mean length of hospital stay was 24 days (range 6 – 49 days). This is the largest Canadian study to assess the timeliness of hospital management of NF in the paediatric population. The large variability in the care of these patients reflects the lack of a standardized approach to their presentation. Given that prompt surgical management is the most important intervention to reduce NF-associated mortality, we have developed an evidence-based streamlining protocol for use in paediatric emergency departments.