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 recog nition is complicated by the difficulty in distinguishing the infection fro m other, less serious soft-tissue infections such as cellulitis. We reviewe d the charts of children presenting with necrotizing fasciitis at a tertiar y care pediatric hospital in Ontario to document potential increases in the frequency of cases and to identify clinical and laboratory features that c ould help distinguish between necrotizing fasciitis and cellulitis. Methods: Necrotizing fasciitis was defined as a soft-tissue infection chara cterized by necrosis of subcutaneous tissue and confirmed at surgery or on pathological examination. A retrospective chart review was conducted to ide ntify cases of necrotizing fasciitis that occurred between June 1, 1983, an d May 31, 1999. The characteristics of the identified cases, their clinical manifestations and the laboratory features at presentation were compared w ith 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 199 1, 1 from 1992 to 1995, and 6 cases from 1990 to 1999. Compared with the ch ildren who had cellulitis, those who had necrotizing fasciitis were more li kely 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 cellulit is to have a history of fever (8/8 v. 10/24, p = 0.004), a higher temperatu re (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 necrotiz ing fasciitis from cellulitis include a generalized erythematous rash, toxi c appearance, fever and low platelet count.