The Epidemiology of Necrotizing Fasciitis at a Rural Level 1 Trauma Center During the COVID-19 Pandemic

Abstract

Introduction The impact of the COVID-19 pandemic on non‐COVID-19 pathologies has been experienced worldwide. While people appropriately avoided social interactions, many also avoided essential medical care for acute and chronic conditions. This delay in seeking care has been associated with increased morbidity and mortality in several conditions, including life-threatening infections such as necrotizing fasciitis. Methods We retrospectively reviewed the records of patients that presented to the University of Vermont Medical Center for necrotizing fasciitis during the 1-year period following the declaration of a global pandemic on March 11, 2020. We subsequently compared this data with that of the previous 4 years. Results During the period of March 12, 2020 to March 12, 2021, there were 17 cases of newly diagnosed necrotizing fasciitis. Compared with an average per year of 8 cases over the previous 4 years, this represents a 113% percent increase in cases of necrotizing fasciitis during the study period ( P = .071861). Out of the 17 cases, 4 patients died during their admission, producing a case-fatality rate of 23.5%. This represents a statistically significant increase from previous years ( P = .003248), where the average case-fatality rate was 6.3%. Conclusion Our study demonstrates a substantial increase in cases of necrotizing fasciitis following the onset of the coronavirus pandemic. A significant increase in the case-fatality rate was also observed. Given the growing body of literature describing the negative impact of the pandemic on non-COVID-19 morbidity and mortality, our study posits necrotizing fasciitis as one of many affected pathologies. Level of Evidence Level IV. Epidemiological

Necrotising Fasciitis During the COVID‐19 Pandemic: An Australian Hospital Network Experience

“…A Spanish study of general surgery reported the same pattern with an increased delay of almost 24 h from the onset of symptoms to arrival at an ED and a decrease in daily cases of emergency general surgeries [15]. Nevertheless, this was contrary to the findings of McGee, et al [16], which showed a 113% increase in cases of NF during the COVID-19 pandemic in the United States. One of the reasons for delayed presentations was patients considered respiratory symptoms of COVID-19 more serious than other non-specific symptoms [17].…”

Necrotising fasciitis: a case series set in rural Australia

“…NF is a serious, rapidly progressive soft tissue infection with Australian mortality rates as high as 18% [ 13 ]. Our review of five cases presenting over a single year reflects the rising incidence of NF globally, likely secondary to the worsening of chronic medical conditions during the Covid-19 pandemic [ 14 ]. Early recognition and early extensive debridement are paramount to successful outcomes.…”