• Jessica Pelletier, Michael Gottlieb, Brit Long, and John C Perkins.
• Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
• J Emerg Med. 2022 Apr 1; 62 (4): 480-491.

BackgroundSkin and soft tissue infections are common emergency department (ED) presentations. These infections cover a wide spectrum of disease, from simple cellulitis to necrotizing fasciitis. Despite the commonality, a subset of skin and soft tissue infections known as necrotizing soft tissue infections (NSTIs) can cause significant morbidity and mortality.ObjectiveThis review evaluates the current evidence regarding the presentation, evaluation, and management of NSTI from the ED perspective.DiscussionNSTIs are commonly missed diagnoses. History and physical examination findings are inconsistent, and the risk factors for this high mortality disease are common amongst ED populations. Laboratory evaluation and the Laboratory Risk in Necrotizing Fasciitis (LRINEC) score is helpful but is insufficient to rule out the disease. Imaging modalities including ultrasound, computed tomography, and magnetic resonance imaging are highly sensitive and specific, but may delay definitive management. The gold standard for diagnosis includes surgical exploration. Surgical intervention and empiric broad-spectrum antibiotic coverage are the foundations of treatment. Adjuvant therapies including hyperbaric oxygen and intravenous immunoglobulin have not yet been proven to be beneficial or to improve outcome.ConclusionNSTIs are associated with significant morbidity and mortality. Knowledge of the history, examination, evaluation, and management is vital for emergency clinicians.Copyright © 2021. Published by Elsevier Inc.

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