The effect of prolonged ED stay on outcome in patients with necrotizing fasciitis

Am J Emerg Med. 2009 May;27(4):385-90. doi: 10.1016/j.ajem.2008.03.010.


Objective: Overcrowding in hospitals, especially in EDs, is a serious problem in the United States, Europe, and Taiwan. However, the association between prolonged ED boarding stay and mortality in patients with necrotizing fasciitis remains underinvestigated.

Methods: This was a retrospective study. A total of 195 patients were enrolled and analyzed. The sample was divided into 2 groups: nonmortality and mortality. A stepwise logistic regression model was developed to investigate 3 factors of clinical relevance predicting patient mortality.

Result: The results of the stepwise logistic regression analysis revealed that hypotension (odds ratio [OR], 32.9; 95% confidence interval [CI], 6.9-156.0) and prolonged ED boarding stay (OR, 3.4; 95% CI 1.3-8.6) were both associated with higher mortality. Early operation (OR: 0.16; 95% CI: 0.06-0.45) was associated with lower mortality.

Conclusion: Prolonged ED boarding stay was associated with increased mortality in patients with necrotizing fasciitis. Early operation (within 24 hours of ED arrival) was associated with decreased mortality.

MeSH terms

  • Emergency Service, Hospital / statistics & numerical data*
  • Fasciitis, Necrotizing / mortality*
  • Fasciitis, Necrotizing / surgery
  • Female
  • Hospital Mortality
  • Humans
  • Length of Stay*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Retrospective Studies
  • Risk Factors
  • Taiwan / epidemiology
  • Waiting Lists*