Objective criteria may assist in distinguishing necrotizing fasciitis from nonnecrotizing soft tissue infection

Am J Surg. 2000 Jan;179(1):17-21. doi: 10.1016/s0002-9610(99)00259-7.


Background: Optimal treatment of necrotizing fasciitis (NF) requires rapid diagnosis. The purpose of the study was to identify objective admission measurements that help differentiate NF from nonnecrotizing (non-NF) infection and, among NF patients, to identify admission factors that predict mortality.

Methods: Twenty-one NF cases were paired with matched non-NF controls. Statistical comparison of admission vital signs, laboratory values, and radiographic studies was performed.

Results: On multivariate analysis, admission white blood cell count (WBC) >14 x 10(9)/L, serum sodium <135 mmol/L, and blood urea nitrogen (BUN) >15 mg/dL separated NF from non-NF patients. Mortality for NF patients was predicted by admission WBC >30 x 10(9)/L. Mortality was also significantly increased for patients transferred from an outside institution prior to definitive therapy.

Conclusions: Objective admission criteria (elevated WBC and BUN and decreased serum sodium) can assist in distinguishing NF from non-NF infections. The best objective predictor of mortality in NF patients is marked elevation of admission WBC.

MeSH terms

  • Adult
  • Blood Urea Nitrogen
  • Case-Control Studies
  • Cellulitis / blood
  • Cellulitis / diagnosis
  • Diagnosis, Differential
  • Fasciitis, Necrotizing / blood
  • Fasciitis, Necrotizing / diagnosis*
  • Fasciitis, Necrotizing / mortality
  • Female
  • Humans
  • Leukocyte Count
  • Male
  • Patient Transfer
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Sensitivity and Specificity
  • Sodium / blood
  • Soft Tissue Infections / blood
  • Soft Tissue Infections / diagnosis*
  • Substance Abuse, Intravenous


  • Sodium