The EGS grading scale for skin and soft-tissue infections is predictive of poor outcomes: A multicenter validation study

Stephanie A. Savage, Shi Wen Li, Garth H. Utter, Jessica A. Cox, Salina M. Wydo, Kevin Cahill, Babak Sarani, Jeremy Holzmacher, Therese M. Duane, Rajesh R. Gandhi, Martin D. Zielinski, Mohamed Ray-Zack, Joshua Tierney, Trinette Chapin, Patrick B. Murphy, Kelly N. Vogt, Thomas J. Schroeppel, Emma Callaghan, Leslie Kobayashi, Raul CoimbraKevin M. Schuster, Devin Gillaspie, Lava Timsina, Alvancin Louis, Marie Crandall

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

INTRODUCTION Over the last 5 years, the American Association for the Surgery of Trauma has developed grading scales for emergency general surgery (EGS) diseases. In a previous validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality. We hypothesized that the grading scale would be predictive of complications, length of stay, and mortality in skin and soft-tissue infections (STIs). METHODS This multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics, and outcomes such as mortality, overall complications, and hospital and ICU length of stay. The EGS scale for STI was used to grade each infection and two surgeons graded each case to evaluate inter-rater reliability. RESULTS 1170 patients were included in this study. Inter-rater reliability was moderate (kappa coefficient 0.472-0.642, with 64-76% agreement). Higher grades (IV and V) corresponded to significantly higher Laboratory Risk Indicator for Necrotizing Fasciitis scores when compared with lower EGS grades. Patients with grade IV and V STI had significantly increased odds of all complications, as well as ICU and overall length of stay. These associations remained significant in logistic regression controlling for age, gender, comorbidities, mental status, and hospital-level volume. Grade V disease was significantly associated with mortality as well. CONCLUSION This validation effort demonstrates that grade IV and V STI are significantly predictive of complications, hospital length of stay, and mortality. Though predictive ability does not improve linearly with STI grade, this is consistent with the clinical disease process in which lower grades represent cellulitis and abscess and higher grades are invasive infections. This second validation study confirms the EGS grading scale as predictive, and easily used, in disparate disease processes. LEVEL OF EVIDENCE Prognostic/Epidemiologic retrospective multicenter trial, level III.

Original languageEnglish (US)
Pages (from-to)601-607
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume86
Issue number4
DOIs
StatePublished - Apr 1 2019
Externally publishedYes

Fingerprint

Soft Tissue Infections
Validation Studies
Multicenter Studies
Emergencies
Length of Stay
Skin
Mortality
Necrotizing Fasciitis
Diverticulitis
Cellulitis
Psychiatric Hospitals
Hospital Mortality
Infection
Abscess
Comorbidity
Logistic Models
Demography
Wounds and Injuries

Keywords

  • EGS grading scales
  • LRINEC score
  • necrotizing fasciitis
  • skin and soft-tissue infections

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

The EGS grading scale for skin and soft-tissue infections is predictive of poor outcomes : A multicenter validation study. / Savage, Stephanie A.; Li, Shi Wen; Utter, Garth H.; Cox, Jessica A.; Wydo, Salina M.; Cahill, Kevin; Sarani, Babak; Holzmacher, Jeremy; Duane, Therese M.; Gandhi, Rajesh R.; Zielinski, Martin D.; Ray-Zack, Mohamed; Tierney, Joshua; Chapin, Trinette; Murphy, Patrick B.; Vogt, Kelly N.; Schroeppel, Thomas J.; Callaghan, Emma; Kobayashi, Leslie; Coimbra, Raul; Schuster, Kevin M.; Gillaspie, Devin; Timsina, Lava; Louis, Alvancin; Crandall, Marie.

In: Journal of Trauma and Acute Care Surgery, Vol. 86, No. 4, 01.04.2019, p. 601-607.

Research output: Contribution to journalArticle

Savage, SA, Li, SW, Utter, GH, Cox, JA, Wydo, SM, Cahill, K, Sarani, B, Holzmacher, J, Duane, TM, Gandhi, RR, Zielinski, MD, Ray-Zack, M, Tierney, J, Chapin, T, Murphy, PB, Vogt, KN, Schroeppel, TJ, Callaghan, E, Kobayashi, L, Coimbra, R, Schuster, KM, Gillaspie, D, Timsina, L, Louis, A & Crandall, M 2019, 'The EGS grading scale for skin and soft-tissue infections is predictive of poor outcomes: A multicenter validation study', Journal of Trauma and Acute Care Surgery, vol. 86, no. 4, pp. 601-607. https://doi.org/10.1097/TA.0000000000002175
Savage, Stephanie A. ; Li, Shi Wen ; Utter, Garth H. ; Cox, Jessica A. ; Wydo, Salina M. ; Cahill, Kevin ; Sarani, Babak ; Holzmacher, Jeremy ; Duane, Therese M. ; Gandhi, Rajesh R. ; Zielinski, Martin D. ; Ray-Zack, Mohamed ; Tierney, Joshua ; Chapin, Trinette ; Murphy, Patrick B. ; Vogt, Kelly N. ; Schroeppel, Thomas J. ; Callaghan, Emma ; Kobayashi, Leslie ; Coimbra, Raul ; Schuster, Kevin M. ; Gillaspie, Devin ; Timsina, Lava ; Louis, Alvancin ; Crandall, Marie. / The EGS grading scale for skin and soft-tissue infections is predictive of poor outcomes : A multicenter validation study. In: Journal of Trauma and Acute Care Surgery. 2019 ; Vol. 86, No. 4. pp. 601-607.
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abstract = "INTRODUCTION Over the last 5 years, the American Association for the Surgery of Trauma has developed grading scales for emergency general surgery (EGS) diseases. In a previous validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality. We hypothesized that the grading scale would be predictive of complications, length of stay, and mortality in skin and soft-tissue infections (STIs). METHODS This multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics, and outcomes such as mortality, overall complications, and hospital and ICU length of stay. The EGS scale for STI was used to grade each infection and two surgeons graded each case to evaluate inter-rater reliability. RESULTS 1170 patients were included in this study. Inter-rater reliability was moderate (kappa coefficient 0.472-0.642, with 64-76{\%} agreement). Higher grades (IV and V) corresponded to significantly higher Laboratory Risk Indicator for Necrotizing Fasciitis scores when compared with lower EGS grades. Patients with grade IV and V STI had significantly increased odds of all complications, as well as ICU and overall length of stay. These associations remained significant in logistic regression controlling for age, gender, comorbidities, mental status, and hospital-level volume. Grade V disease was significantly associated with mortality as well. CONCLUSION This validation effort demonstrates that grade IV and V STI are significantly predictive of complications, hospital length of stay, and mortality. Though predictive ability does not improve linearly with STI grade, this is consistent with the clinical disease process in which lower grades represent cellulitis and abscess and higher grades are invasive infections. This second validation study confirms the EGS grading scale as predictive, and easily used, in disparate disease processes. LEVEL OF EVIDENCE Prognostic/Epidemiologic retrospective multicenter trial, level III.",
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T1 - The EGS grading scale for skin and soft-tissue infections is predictive of poor outcomes

T2 - A multicenter validation study

AU - Savage, Stephanie A.

AU - Li, Shi Wen

AU - Utter, Garth H.

AU - Cox, Jessica A.

AU - Wydo, Salina M.

AU - Cahill, Kevin

AU - Sarani, Babak

AU - Holzmacher, Jeremy

AU - Duane, Therese M.

AU - Gandhi, Rajesh R.

AU - Zielinski, Martin D.

AU - Ray-Zack, Mohamed

AU - Tierney, Joshua

AU - Chapin, Trinette

AU - Murphy, Patrick B.

AU - Vogt, Kelly N.

AU - Schroeppel, Thomas J.

AU - Callaghan, Emma

AU - Kobayashi, Leslie

AU - Coimbra, Raul

AU - Schuster, Kevin M.

AU - Gillaspie, Devin

AU - Timsina, Lava

AU - Louis, Alvancin

AU - Crandall, Marie

PY - 2019/4/1

Y1 - 2019/4/1

N2 - INTRODUCTION Over the last 5 years, the American Association for the Surgery of Trauma has developed grading scales for emergency general surgery (EGS) diseases. In a previous validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality. We hypothesized that the grading scale would be predictive of complications, length of stay, and mortality in skin and soft-tissue infections (STIs). METHODS This multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics, and outcomes such as mortality, overall complications, and hospital and ICU length of stay. The EGS scale for STI was used to grade each infection and two surgeons graded each case to evaluate inter-rater reliability. RESULTS 1170 patients were included in this study. Inter-rater reliability was moderate (kappa coefficient 0.472-0.642, with 64-76% agreement). Higher grades (IV and V) corresponded to significantly higher Laboratory Risk Indicator for Necrotizing Fasciitis scores when compared with lower EGS grades. Patients with grade IV and V STI had significantly increased odds of all complications, as well as ICU and overall length of stay. These associations remained significant in logistic regression controlling for age, gender, comorbidities, mental status, and hospital-level volume. Grade V disease was significantly associated with mortality as well. CONCLUSION This validation effort demonstrates that grade IV and V STI are significantly predictive of complications, hospital length of stay, and mortality. Though predictive ability does not improve linearly with STI grade, this is consistent with the clinical disease process in which lower grades represent cellulitis and abscess and higher grades are invasive infections. This second validation study confirms the EGS grading scale as predictive, and easily used, in disparate disease processes. LEVEL OF EVIDENCE Prognostic/Epidemiologic retrospective multicenter trial, level III.

AB - INTRODUCTION Over the last 5 years, the American Association for the Surgery of Trauma has developed grading scales for emergency general surgery (EGS) diseases. In a previous validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality. We hypothesized that the grading scale would be predictive of complications, length of stay, and mortality in skin and soft-tissue infections (STIs). METHODS This multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics, and outcomes such as mortality, overall complications, and hospital and ICU length of stay. The EGS scale for STI was used to grade each infection and two surgeons graded each case to evaluate inter-rater reliability. RESULTS 1170 patients were included in this study. Inter-rater reliability was moderate (kappa coefficient 0.472-0.642, with 64-76% agreement). Higher grades (IV and V) corresponded to significantly higher Laboratory Risk Indicator for Necrotizing Fasciitis scores when compared with lower EGS grades. Patients with grade IV and V STI had significantly increased odds of all complications, as well as ICU and overall length of stay. These associations remained significant in logistic regression controlling for age, gender, comorbidities, mental status, and hospital-level volume. Grade V disease was significantly associated with mortality as well. CONCLUSION This validation effort demonstrates that grade IV and V STI are significantly predictive of complications, hospital length of stay, and mortality. Though predictive ability does not improve linearly with STI grade, this is consistent with the clinical disease process in which lower grades represent cellulitis and abscess and higher grades are invasive infections. This second validation study confirms the EGS grading scale as predictive, and easily used, in disparate disease processes. LEVEL OF EVIDENCE Prognostic/Epidemiologic retrospective multicenter trial, level III.

KW - EGS grading scales

KW - LRINEC score

KW - necrotizing fasciitis

KW - skin and soft-tissue infections

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