Validation of the American Association for the Surgery of Trauma emergency general surgery grade for skin and soft tissue infection

Mohamed Ray-Zack, Matthew C. Hernandez, Moustafa Younis, Wyatt B. Hoch, Dylan S. Soukup, Nadeem N. Haddad, Martin D. Zielinski

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

INTRODUCTION Skin and soft tissue infections (SSTIs) present with variable severity. The American Association for the Surgery of Trauma (AAST) developed an emergency general surgery (EGS) grading system for several diseases. We aimed to determine whether the AAST EGS grade corresponds with key clinical outcomes. METHODS Single-institution retrospective review of patients (≥18 years) admitted with SSTI during 2012 to 2016 was performed. Patients with surgical site infections or younger than 18 years were excluded. Laboratory Risk Indicator for Necrotizing Fasciitis score and AAST EGS grade were assigned. The primary outcome was association of AAST EGS grade with complication development, duration of stay, and interventions. Secondary predictors of severity included tissue cultures, cross-sectional imaging, and duration of inpatient antibiotic therapy. Summary and univariate analyses were performed. RESULTS A total of 223 patients were included (mean ± SD age of 55.1 ± 17.0 years, 55% male). The majority of patients received cross sectional imaging (169, 76%) or an operative procedure (155, 70%). Skin and soft tissue infection tissue culture results included no growth (51, 24.5%), monomicrobial (83, 39.9%), and polymicrobial (74, 35.6%). Increased AAST EGS grade was associated with operative interventions, intensive care unit utilization, complication severity (Clavien-Dindo index), duration of hospital stay, inpatient antibiotic therapy, mortality, and hospital readmission. CONCLUSION The AAST EGS grade for SSTI demonstrates the ability to correspond with several important outcomes. Prospective multi-institutional study is required to determine its broad generalizability in several populations. LEVEL OF EVIDENCE Prognostic, level IV.

Original languageEnglish (US)
Pages (from-to)939-945
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume84
Issue number6
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

Fingerprint

Soft Tissue Infections
Emergencies
Skin
Wounds and Injuries
Inpatients
Anti-Bacterial Agents
Necrotizing Fasciitis
Surgical Wound Infection
Patient Readmission
Operative Surgical Procedures
Intensive Care Units
Length of Stay

Keywords

  • AAST EGS grade
  • LRINEC
  • outcomes
  • severity
  • SSTI

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Validation of the American Association for the Surgery of Trauma emergency general surgery grade for skin and soft tissue infection. / Ray-Zack, Mohamed; Hernandez, Matthew C.; Younis, Moustafa; Hoch, Wyatt B.; Soukup, Dylan S.; Haddad, Nadeem N.; Zielinski, Martin D.

In: Journal of Trauma and Acute Care Surgery, Vol. 84, No. 6, 01.06.2018, p. 939-945.

Research output: Contribution to journalArticle

Ray-Zack, Mohamed ; Hernandez, Matthew C. ; Younis, Moustafa ; Hoch, Wyatt B. ; Soukup, Dylan S. ; Haddad, Nadeem N. ; Zielinski, Martin D. / Validation of the American Association for the Surgery of Trauma emergency general surgery grade for skin and soft tissue infection. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 84, No. 6. pp. 939-945.
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AU - Soukup, Dylan S.

AU - Haddad, Nadeem N.

AU - Zielinski, Martin D.

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N2 - INTRODUCTION Skin and soft tissue infections (SSTIs) present with variable severity. The American Association for the Surgery of Trauma (AAST) developed an emergency general surgery (EGS) grading system for several diseases. We aimed to determine whether the AAST EGS grade corresponds with key clinical outcomes. METHODS Single-institution retrospective review of patients (≥18 years) admitted with SSTI during 2012 to 2016 was performed. Patients with surgical site infections or younger than 18 years were excluded. Laboratory Risk Indicator for Necrotizing Fasciitis score and AAST EGS grade were assigned. The primary outcome was association of AAST EGS grade with complication development, duration of stay, and interventions. Secondary predictors of severity included tissue cultures, cross-sectional imaging, and duration of inpatient antibiotic therapy. Summary and univariate analyses were performed. RESULTS A total of 223 patients were included (mean ± SD age of 55.1 ± 17.0 years, 55% male). The majority of patients received cross sectional imaging (169, 76%) or an operative procedure (155, 70%). Skin and soft tissue infection tissue culture results included no growth (51, 24.5%), monomicrobial (83, 39.9%), and polymicrobial (74, 35.6%). Increased AAST EGS grade was associated with operative interventions, intensive care unit utilization, complication severity (Clavien-Dindo index), duration of hospital stay, inpatient antibiotic therapy, mortality, and hospital readmission. CONCLUSION The AAST EGS grade for SSTI demonstrates the ability to correspond with several important outcomes. Prospective multi-institutional study is required to determine its broad generalizability in several populations. LEVEL OF EVIDENCE Prognostic, level IV.

AB - INTRODUCTION Skin and soft tissue infections (SSTIs) present with variable severity. The American Association for the Surgery of Trauma (AAST) developed an emergency general surgery (EGS) grading system for several diseases. We aimed to determine whether the AAST EGS grade corresponds with key clinical outcomes. METHODS Single-institution retrospective review of patients (≥18 years) admitted with SSTI during 2012 to 2016 was performed. Patients with surgical site infections or younger than 18 years were excluded. Laboratory Risk Indicator for Necrotizing Fasciitis score and AAST EGS grade were assigned. The primary outcome was association of AAST EGS grade with complication development, duration of stay, and interventions. Secondary predictors of severity included tissue cultures, cross-sectional imaging, and duration of inpatient antibiotic therapy. Summary and univariate analyses were performed. RESULTS A total of 223 patients were included (mean ± SD age of 55.1 ± 17.0 years, 55% male). The majority of patients received cross sectional imaging (169, 76%) or an operative procedure (155, 70%). Skin and soft tissue infection tissue culture results included no growth (51, 24.5%), monomicrobial (83, 39.9%), and polymicrobial (74, 35.6%). Increased AAST EGS grade was associated with operative interventions, intensive care unit utilization, complication severity (Clavien-Dindo index), duration of hospital stay, inpatient antibiotic therapy, mortality, and hospital readmission. CONCLUSION The AAST EGS grade for SSTI demonstrates the ability to correspond with several important outcomes. Prospective multi-institutional study is required to determine its broad generalizability in several populations. LEVEL OF EVIDENCE Prognostic, level IV.

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