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. 2025 May 9;17(5):e83814.
doi: 10.7759/cureus.83814. eCollection 2025 May.

A Study on the Accuracy of Point-of-Care Ultrasound in the Diagnosis and Management of Necrotizing Fasciitis

Affiliations

A Study on the Accuracy of Point-of-Care Ultrasound in the Diagnosis and Management of Necrotizing Fasciitis

Eswar Medikonda et al. Cureus. .

Abstract

Background Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection with high mortality rates. Early diagnosis and prompt surgical intervention are crucial for survival, yet the initial diagnosis remains challenging due to nonspecific early presentations. This study evaluated the diagnostic accuracy of point-of-care ultrasound (POCUS) in identifying NF and its utility in guiding clinical management decisions. Methods This prospective observational study included 85 patients with suspected NF at a tertiary care center in India from April 2023 to April 2025. Trained emergency physicians performed POCUS examinations using high-frequency linear transducers and low-frequency curvilinear transducers when necessary. Sonographic findings were documented and correlated with surgical observations, clinical outcomes, and laboratory parameters. Primary outcomes included POCUS diagnostic accuracy, the need for surgical intervention, and mortality rates. Results The study population had a mean age of 50.2 years, with male predominance (62.4%) and primarily lower limb involvement (77.6%). POCUS demonstrated high positivity (97.6%) with predominantly fluid collection (77.6%), the loss of vascularity (65.9%), and fascial thickening (52.9%). Sensitivity was highest for fascial thickening (97.1%) and fluid collection (92.5%). Most required multiple debridements (83.5%), with 43.5% undergoing three procedures. At three-week follow-up, 25.9% achieved partial recovery and 18.8% complete recovery, with 15.3% mortality. Complications included amputation (11.8%), sepsis (9.4%), and wound infection (8.2%). POCUS assessment at three weeks showed persistent changes in 36.5% of patients despite clinical improvement in many cases. Conclusion POCUS is a highly sensitive diagnostic tool for NF with excellent correlation to surgical findings. Its immediate availability, non-invasive nature, and repeatability position it as a valuable adjunct in the initial assessment and monitoring of this life-threatening condition. The integration of POCUS into standard assessment protocols for suspected NF can expedite diagnosis, guide surgical interventions, and improve clinical outcomes.

Keywords: clinical outcomes; diagnostic accuracy; laboratory risk indicator for necrotizing fasciitis (lrinec) score; mortality; necrotizing fasciitis; point-of-care ultrasound; soft tissue infection; surgical debridement.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Ethical Committee of Bijapur Lingayat District Educational (BLDE) (Deemed to be University) issued approval BLDE(DU)/IEC/924/2023-24. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Images showing fluid collection
Figure 2
Figure 2. Pie chart showing clinical outcomes at three weeks
Figure 3
Figure 3. Bar graph showing POCUS assessment at three weeks
POCUS: point-of-care ultrasound

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