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. 2018 Aug 28;18(1):429.
doi: 10.1186/s12879-018-3355-7.

Signs, symptoms and diagnosis of necrotizing fasciitis experienced by survivors and family: a qualitative Nordic multi-center study

Annette Erichsen Andersson  1   2 , Ingrid Egerod  3   4 , Vibeke E Knudsen  4 , Ann-Mari Fagerdahl  5
Affiliations

Signs, symptoms and diagnosis of necrotizing fasciitis experienced by survivors and family: a qualitative Nordic multi-center study

Annette Erichsen Andersson et al. BMC Infect Dis. .

Abstract

Background: Necrotizing soft tissue infection is the most serious of all soft tissue infections. The patient's life is dependent on prompt diagnosis and aggressive treatment. Diagnostic delays are related to increased morbidity and mortality, and the risk of under- or missed diagnosis is high due to the rarity of the condition. There is a paucity of knowledge regarding early indications of disease. The aim of the study has thus been to explore patients' and families' experiences of early signs and symptoms and to describe their initial contact with the healthcare system.

Methods: A qualitative explorative design was used to gain more knowledge about the experience of early signs and symptoms. Fifty-three participants from three study sites were interviewed. The framework method was used for data analysis.

Results: Most of the participants experienced treatment delay and contacted healthcare several times before receiving correct treatment. The experience of illness varied among the participants depending on the duration of antecedent signs and symptoms. Other important findings included the description of three stages of early disease progression with increase in symptom intensity. Pain experienced in necrotizing soft tissue infections is particularly excruciating and unresponsive to pain medication. Other common symptoms were dyspnea, shivering, muscle weakness, gastrointestinal problems, anxiety, and fear.

Conclusion: Our study adds to the understanding of the lived experience of NSTI by providing in-depth description of antecedent signs and symptoms precipitating NSTI-diagnosis. We have described diagnostic delay as patient-related, primary care related, or hospital related and recommend that patient and family narratives should be considered when diagnosing NSTI to decrease diagnostic delay.

Keywords: Diagnosis; Family perspective; Necrotizing soft tissue infection; Patient experiences; Qualitative study; Signs and symptoms.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Regional Ethics Review Board in Gothenburg, Sweden (No. 930–12), the Danish Data Protection Agency and the National Committee on Health Research Ethics in Denmark (No. 48205). The Declaration of Helsinki [35] was followed and the interviewees were informed about the study and that confidentiality was guaranteed. Information and written consent for this sub-study and INFECT were given at the acute stage of illness and obtained concurrently to reduce the strain on patients and/or next of kin acting as proxy for the patient.

Consent for publication

Written and oral consent has been obtained from all participant.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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