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- W4377019263 abstract "Introduction Necrotizing Fasciitis (NF) is a life-threatening infection and a surgical emergency. Not all clinicians may have the experience or resources to detect NF in its early stages. Objective To develop a diagnostic algorithm for primary care and emergency physicians to identify patients with possible NF, including an initial approach to triaging such individuals. Methods Medline was searched to identify studies of validated algorithms for NF diagnosis and/or cohort or case series providing clinical and diagnostic features of NF. Candidate algorithms were validated by applying the algorithm to three published cases of initially misdiagnosed NF. A retrospective review of NF cases between 2011-2022 at our center was performed to allow for validation of our algorithm. Results The search yielded 540 articles out of which 109 manuscripts were included following review of abstracts. No published validated diagnostic algorithm was identified. Rather, using the literature describing clinical and diagnostic features of NF, we generated an algorithm of the “3Ds” of NF: Disproportionate pain, Dermatological findings and Disorganized physiology. As the number of Ds increases, so does the level of suspicion for NF and prioritization for urgent surgical consultation. In the three published cases of missed NF, the 3Ds algorithm successfully identified all three as having possible NF. In review of our cases, we identified 56 patients with NF during an 11 year period. 66% of these patients had the 3Ds at initial presentation to hospital. Discussion The 3Ds algorithm, a simple and memorable tool is easily applied in a primary or emergency care setting, may improve the early diagnosis of NF. Retrospective analysis of NF cases allows for validation of this algorithm. Prospective validation of this algorithm is required." @default.
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- W4377019263 date "2023-09-01" @default.
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- W4377019263 title "Three Ds for diagnosing necrotizing fasciitis by front-line clinicians" @default.
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- W4377019263 doi "https://doi.org/10.1016/j.bjps.2023.05.020" @default.
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