i.CONiC improving Clinical Outcomes in Necrotizing FasCiitis
A national audit of current clinical practice
Necrotising fasciitis (NF) is a clinical diagnosis that is defined by a rapidly progressing, life threatening infection of the fascia with associated necrosis of the subcutaneous tissue and skin. Whilst it causes significant morbidity and mortality, it is a mercurial disease with a variable spectrum of presentation, investigative results and causative organisms. Regardless of the advances in critical care, microbiology and introduction of scoring systems to aid prompt diagnosis, the mortality associated with NF remains 25% to 35% with mortality being directly proportional to time to primary debridement. To date there have been no national studies and limited data about the overall incidence and prevalence. There is no established practice or standardization of care for NF in the UK.
The intention of this national audit is to establish the current trends in pathophysiological presentation, microbiological and surgical management of NF in the UK. With this we seek to gain insight into the extent and nature of the disease with the ultimate goal of establishing a standard of care / national guidance that will improve the mortality and morbidity experienced by patients.
Aims
- To determine the current national scope and burden of disease
- Gather data on the current surgical and medical management of NF
- Generate national statistics on the morbidity and mortality of NF
- Produce national guidelines on the management of NF
- Improve standards of care and national reporting of invasive soft tissue infections
Patient population
All patients with a diagnosis of NF at the participating centres in the UK will be enrolled who meet the criteria for inclusion. The audit will be for a 12 month period, subject to review at the interim data monitoring committee meeting.
| Inclusion Criteria: |
| Absolute Inclusion Criteria:1) Clinical diagnosis of necrotizing fasciitis requiring surgical debridement of superficial and/or deep fascia. |
| Exclusion Criteria: |
| 1) No debridement of superficial or deep fascia2) Negative exploratory surgery
3) Antibiotic management of soft tissue infection with no operative intervention |
Working Party
Mr Patrick Gillespie – Chief Investigator
Mr David Wallace – Co-chief Investigator
Mr Abhi Jain – Co-chief Investigator
Miss Suzanne Murphy – Cambridge Trainee Lead
Mr David Morgan-Jones – Cambridge
Mr Graeme Glass – RSTN Trainee Representative
Mr Matthew Gardiner – Trainee Lead, RSTN
How to get involved
We are keen to have as many participating centres as possible. Each participating centre will need a local trainee representative who will be responsible for recruitment and local data collection.
We will be organising a working group meeting in 2015 and details of the date and venue will be posted here.
If you are keen to participate please register your interest by emailing:
Suzanne Murphy sm2073@cam.ac.uk
David Morgan-Jones davidmj@me.com
Patrick Gillespie patrick.gillespie@nhs.net