Anitha, Muthusami (2014) Prognostic indicators of morbidity and mortality in non diabetic soft tissue infections. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Soft tissue skin infections (SSTI’s) were first described in the Hippocratic era. The principles of management, including early diagnosis with prompt and repeated surgical debridement, aggressive resuscitation and physiological support, broad spectrum antimicrobial drugs, and nutritional support, have been well documented. Despite this well accepted management approach, the mortality rate remains between 16 – 34% in most major published series. Due to the lack of defined criteria to determine the type of treatment that has to be given for patients at the time of admission, most patients undergo multiple surgical procedures which increases the morbidity and mortality. AIM OF THE STUDY: The primary objective of this analysis is to create a simple clinical score to aid in the prediction of morbidity defined by the number of days of hospital stay or limb loss and mortality in patients with SSTIs at the time of first assessment. The scoring system may further be used to predict limb loss at first assessment, thereby reducing multiple surgeries for the same patient. METHODS: A retrospective review of 200 consecutive patients with necrotizing soft tissue infections, treated at Rajiv Gandhi Government General Hospital during a 1-year period, was conducted. Using a model for logistic regression analysis, characteristics of each patient and his/her clinical course were tested for impact on outcome. The variables which were found to independently alter the outcome were used to establish a scoring system. This was then applied to a prospective pool of 50 patients admitted over 6 months in the same hospital. RESULTS: The scoring system decreased the number of surgeries undergone by each patient significantly. The scoring system also reduced the number of days of hospital stay per patients, though not significantly. The use of the scoring system did not alter the mortality in any way. CONCLUSION: Skin and soft tissue infections of the limbs have a high mortality and morbidity especially if necrosis is present. The morbidity is in the form of prolonged hospital stay and limb loss. Further detailed studies are required to produce repeated significant results, which is essential for the scoring system to be applied as an established protocol.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Prognostic indicators ; morbidity ; mortality ; non diabetic soft tissue infections. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 24 Jun 2018 17:57 |
| Last Modified: | 24 Jun 2018 17:57 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8608 |
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