Assessment of functional limitation after necrotizing soft tissue infection

Abstract

Previous literature on necrotizing soft tissue infections (NSTIs) has focused on its diagnosis and high mortality, but to our knowledge, none have reported on the functional outcomes of patients surviving this devastating disease. The purpose of this study was to evaluate the management and assess factors associated with decreased physical function in patients who survived this life-threatening infection. A retrospective review was conducted on patients treated for NSTI in whom an evaluation of functional status was performed between 2002 and 2006. Measurements were based on the American Medical Association Guides of impairment rating, and categorized into a functional class from "minimal or no limitation" to "severe limitation." Multivariate analyses were performed to discern independent factors associated with functional limitation. Final disposition status after discharge was also recorded. A total of 297 patients were treated for NSTI during this time. Of these, 119 (41%) patients met inclusion criteria for review. Mean number of débridements and coverage procedures were 3.4 and 2.0, respectively. Although mean percent functional limitation was 7.1, which is classified as "minimal or no limitation," 30% of patients had "mild" to "severe" functional limitation. Extremity involvement was independently associated with a higher functional limitation class (P < .01). Functional limitation may challenge recovery from NSTI in many survivors. In this series, the involvement of an extremity predicted a higher functional limitation class at the time of discharge. Development of validated functional assessment tools and accurate longitudinal follow-up are necessary to measure the functional impact of NSTI.

Figure 1

Flowchart of patients admitted to Harborview Medical Center for NSTI during study period (2002–2006).